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Brain Aneurysm Repair

By

Sarah Lewis, PharmD

What is brain aneurysm repair?

Brain aneurysm repair is surgery to fix a cerebral (brain) aneurysm. An aneurysm is a weakened area in a blood vessel wall that widens and bulges. Over time, this weakened area can grow, stretch, balloon outward, and possibly rupture (burst). There is a significant risk of death associated with a ruptured cerebral aneurysm. Brain aneurysm repair is a treatment for cerebral aneurysms aimed at preventing rupture and hemorrhaging or bleeding into the brain.

Brain aneurysm repair is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a having brain aneurysm repair.

Types of brain aneurysm repair

The types of brain aneurysm repair procedures include:

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  • Clipping involves placing a small, metal clip around the base of your cerebral aneurysm. This prevents it from bursting or rupturing. Your doctor must remove part of your skull in order to place the clip. After the clipping, your doctor will reattach the piece of skull. Doctors also use this surgery in an emergency after a cerebral aneurysm has burst.

  • Endovascular coil embolization, or coiling, involves inserting a catheter into a blood vessel in your groin or arm. Your doctor feeds or guides the catheter wire to the area in the brain where the aneurysm is located. Your doctor uses X-rays to help guide the catheter to the correct position. Once in position, your doctor inserts tiny metal coils inside your aneurysm. This causes the aneurysm to clot off and prevents rupture.

Other procedures that may be performed

Your doctor may perform other procedures in addition to brain aneurysm repair. These include:

  • Occlusion involves clamping or occluding the artery that leads to your cerebral aneurysm. This procedure is usually done when an aneurysm has damaged the artery.

  • Bypass involves using a blood vessel taken from somewhere else in your body to create a new route around a damaged cerebral artery. A bypass is usually done along with an occlusion.

Why is brain aneurysm repair performed? 

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.

Who performs brain aneurysm repair?

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.

How is brain aneurysm repair performed?

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 ane