Brain Aneurysm Repair

Brain aneurysm repair is a major surgical procedure that your doctor may recommend to treat a cerebral aneurysm. An aneurysm is a weakened area in a blood vessel wall that widens and bulges. Over time, this weakened area can grow, stretch, and balloon outward. Aneurysms are serious health conditions because they can burst and cause life-threatening bleeding.

Not all cerebral aneurysms need to be treated. Small aneurysms are less likely to burst and may only require frequent monitoring and imaging. 

Your doctor will evaluate many factors when considering brain aneurysm repair. These include the size and location of your aneurysm, the presence or absence of symptoms, your age and medical conditions, and the presence or absence of other risk factors for aneurysm rupture.

Your doctor may only recommend brain aneurysm repair if other treatment options with less risk of complications have failed. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on brain aneurysm repair.

Your doctor may recommend brain aneurysm repair if your aneurysm is:

• Causing symptoms. Most cerebral aneurysms do not have any symptoms. When they occur, symptoms of a cerebral aneurysm may include headache, double vision, eye pain, weakness, numbness, and dizziness. If you are having symptoms, it may be a sign that your cerebral aneurysm is about to burst. This is a medical emergency.

• Large or growing rapidly. Cerebral aneurysms that are greater than 10 millimeters (less than four-tenths of an inch) in diameter have a greater risk of rupturing.

• Located in the back part of your brain. This particular location has an increased risk of rupturing.

• Leaking blood into the layers of the walls of your blood vessel. This is called a dissection.

• Ruptured or burst. A ruptured cerebral aneurysm is a medical emergency. Symptoms that your cerebral aneurysm has ruptured or burst include severe headache, stiff neck, nausea, vomiting, sensitivity to light (photophobia), dilated pupils, drowsiness, and loss of consciousness.

The following specialists perform brain aneurysm repair:

• Neurosurgeons specialize in the surgical care of diseases of the brain and nervous system.

• Neuroradiologists are doctors who specialize in diagnosing and treating diseases of the brain and nervous system using radiological imaging.

• Pediatric neurosurgeons specialize in the surgical care of children with diseases and conditions of the brain and nervous system.

Your brain aneurysm repair will be performed in a hospital. 

Surgical approaches to brain aneurysm repair

Brain aneurysm repair may be performed using one of the following approaches:

• Minimally invasive surgery or endovascular coiling surgery involves inserting a catheter (tube) and guide wire through an artery in your groin or leg. Your doctor feeds or guides the catheter guide wire to your cerebral aneurysm. The catheter tip has detachable metal coils that are inserted in the aneurysm once the catheter is in place. The coils cause the aneurysm to clot off and prevent it from rupturing. Endovascular surgery generally involves a faster recovery and less pain than open surgery. It may be a good option if you are not a candidate for open surgery. Not all aneurysms can be repaired with this procedure.
   

• Open surgery or clipping involves making an incision in your scalp and removing a piece of your skull. Your surgeon will place a small metal clip around the base of your cerebral aneurysm to stop blood from flowing into it. Your surgeon will reattach the piece of your skull once the procedure is complete. Open surgery allows your doctor to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery involves more cutting and displacement of tissues and organs than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different brain aneurysm repair procedures and ask why your doctor will use a certain procedure for you.
Types of anesthesia that may be used

Your doctor will perform brain aneurysm repair using either general anesthesia or regional anesthesia, depending on the specific procedure. 

• General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

• Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your brain aneurysm repair

The day of your surgery, you can generally expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

• A surgical team member will start an IV.

• The anesthesiologist or nurse anesthetist will start your anesthesia.

• A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

As with all surgeries, brain aneurysm repair involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock or require blood transfusion

• Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis

• Infection

Potential complications of brain aneurysm repair

Complications of brain aneurysm repair include:

• Damage to blood vessels

• Death

• Neurological problems, such as problems with vision, speech, memory, coordination, balance, and muscle control. They can range from mild to severe and can be temporary or permanent.

• Seizures

• Stroke

• Swelling of the brain

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and:

• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

• Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

• Taking your medications exactly as directed

• Telling all members of your care team if you have any allergies 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for brain aneurysm repair by:

• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include blood tests and other tests as needed.

• Losing excess weight before the surgery through a healthy diet and exercise plan

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions and a friend or family member to your appointments. Questions can include:

• Why do I need brain aneurysm repair? Are there any other options for treating my condition?

• Which type of procedure do I need?

• How long will the surgery take? When can I go home?

• What restrictions will I have after the surgery? When can I return to work and other activities?

• What kind of assistance will I need at home?

• What medications will I need before and after the surgery? How do I take my regular medications?

• How will you treat my pain?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect can help make your road to recovery after brain aneurysm repair as smooth as possible. 

How long will it take to recover?

After your procedure, your care team will move you directly to an intensive care unit (ICU). ICUs provide 24-hour monitoring and specialized care. 

It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids. 

You will not be able to talk if you have a breathing tube. It is usually removed within a few days. You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable. 

You will move to a hospital room outside the ICU as you recover. A typical hospital stay for endovascular (minimally invasive) coiling surgery is one to two days. A typical hospital stay for open surgery or clipping is four to six days. Your doctor may refer you to a rehabilitation program to help you recover.

Full recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes a few weeks to a few months.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after brain aneurysm repair.  Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding

• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

• Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion

• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

• Inability to urinate or have a bowel movement

• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

• Pain that is not controlled by your pain medication

• Unexpected drainage, pus, redness or swelling of your incision

How might brain aneurysm repair affect my everyday life?

Brain aneurysm repair may cure your condition so you can lead an active, normal life. It also causes significant changes to your body that may affect your everyday life, such as the need to:

• Have frequent follow-up visits and imaging tests to check the coil that was placed in endovascular coiling surgery

• Notify all of your healthcare providers about your brain aneurysm repair. You may not be able to have certain testing procedures such as MRI.

• Treat other conditions including high blood pressure, high cholesterol, and diabetes