Brain aneurysm repair
Brain aneurysm repair is surgery to correct an aneurysm. This is a weak area in a blood vessel wall that causes the vessel to bulge or balloon out and sometimes burst (rupture). It may cause:
- Bleeding into the area around the brain (also called a subarachnoid hemorrhage)
- Bleeding into the brain that forms a collection of blood (hematoma)
Aneurysm repair - cerebral; Cerebral aneurysm repair; Coiling; Saccular aneurysm repair; Berry aneurysm repair; Fusiform aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm
There are two common methods used to repair an aneurysm:
- Clipping is done during an open craniotomy.
- Endovascular repair, most often using a coil or coiling and stenting (mesh tubes), is a less invasive way to treat some aneurysms.
During aneurysm clipping:
- You are given general anesthesia and a breathing tube.
- Your scalp, skull, and the coverings of the brain are opened.
- A metal clip is placed at the base (neck) of the aneurysm to prevent it from breaking open (bursting).
During endovascular repair of an aneurysm:
- You may have general anesthesia and a breathing tube. Or, you may be given medicine to relax you, but not enough to put you to sleep.
- A catheter is guided through a small cut in your groin to an artery and then to the blood vessel in your brain where the aneurysm is located.
- Contrast material is injected through the catheter. This allows the surgeon to view the arteries and the aneurysm on a monitor in the operating room.
- Thin metal wires are put into the aneurysm. They then coil into a mesh ball. For this reason, the procedure is also called coiling. Blood clots that form around this coil prevent the aneurysm from breaking open and bleeding. Sometimes stents (mesh tubes) are also put in to hold the coils in place.
- During and right after the procedure, you may be given heparin. This medicine prevents dangerous blood clots from forming.
Why the Procedure Is Performed
If an aneurysm in the brain breaks open (ruptures), it is an emergency that needs medical treatment. Often a rupture is treated with surgery. Endovascular repair is more often used when this happens.
- Not all aneurysms need to be treated right away. Aneurysms that have never bled and are very small (less than 3 mm at their largest point) do not need to be treated right away. These aneurysms are less likely to break open (rupture).
- Your doctor will help you decide whether it is safer to have surgery to block off the aneurysm before it can break open or to observe the aneurysm until surgery becomes necessary.
Risks of anesthesia are:
- Breathing problems
- Reactions to medications
Risks of brain surgery are:
- Blood clot or bleeding in the brain
- Brain swelling
- Infection in the brain or parts around the brain, such as the skull or scalp
Surgery on any one area of the brain may cause problems with speech, memory, muscle weakness, balance, vision, coordination, and other functions. These problems may be mild or severe. They may last a short while or they may not go away.
Signs of brain and nervous system (neurological) problems include:
Before the Procedure
This procedure is often performed on an emergency basis. If it is not an emergency:
- Tell your doctor or nurse what drugs or herbs you are taking and if you have been drinking a lot of alcohol.
- Ask your doctor which drugs you should still take on the morning of the surgery.
- Try to stop smoking.
- You will be asked not to eat or drink anything for 8 hours before the surgery.
- Take the drugs your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you when to arrive.
- Arrive at the hospital on time.
After the Procedure
A hospital stay for endovascular repair of an aneurysm may be as short as 1 to 2 days if there was no bleeding before surgery.
The hospital stay after craniotomy and aneurysm clipping is usually 4 to 6 days. When bleeding or other complications occur before or during surgery, the hospital stay can be 1 to 2 weeks, or longer.
You will probably have imaging tests of the blood vessels (angiogram) in the brain before you are sent home.
Ask your doctor if it will be safe for you to have MRI scans of the head in the future.
After successful surgery for a bleeding aneurysm, it is uncommon for it to bleed again.
The outlook also depends on whether brain damage occurred from bleeding before, during, or after surgery.
Most of the time, surgical repair can prevent a brain aneurysm that has not caused symptoms from becoming larger and breaking open.
You may have more than one aneurysm or the aneurysm that was coiled might grow back. After coiling repair, you will need to be seen by your health care provider every year.
Bederson JB, Connolly ES Jr., Batjer HH, et al. American Heart Association Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40:994-1025. PMID: 19164800 www.ncbi.nlm.nih.gov/pubmed/19164800.
Bowles E. Cerebral aneurysm and aneurysmal subarachnoid haemorrhage. Nurs Stand. 2014;28:52-59. PMID: 24749614 www.ncbi.nlm.nih.gov/pubmed/24749614.
Mack W, Dusick JR, Martin N, Gonzalez N. Principles of endovascular therapy. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 47.
Meyers PM, Schumacher HC, Higashida RT, Barnwell SL, Creager MA, Gupta R, et al. American Heart Association Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009;119:2235-49. PMID: 19349327 www.ncbi.nlm.nih.gov/pubmed/19349327.
Tenjin H, Tanigawa, S, Takadou M, et al. Progress in the treatment of unruptured aneurysms. Trends in Neurovascular Interventions. Acta Neurochirurgica Supplement. 2014;119:33-38. PMID: 24728629 www.ncbi.nlm.nih.gov/pubmed/24728629.
Reviewed By: Luc Jasmin, MD, PhD, Department of Surgery Providence Hospital, Medford, OR, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, CA, and Department of Oral and Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.