Brain aneurysm repair
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 - aneurysmBrain aneurysm repair is surgery to correct an aneurysm in or near the brain. 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:
Aneurysm
An aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. When an aneurysm occurs in a blood ve...
Read Article Now Book Mark Article- Bleeding into the cerebrospinal fluid (CSF) around the brain (also called a subarachnoid hemorrhage)
Subarachnoid hemorrhage
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid sp...
Read Article Now Book Mark Article - Bleeding into the brain that forms a collection of blood (intracerebral hemorrhage with hematoma)
- Mass effect on nerves
Description
There are two common methods used to repair an aneurysm:
- Clipping is done during an open craniotomy.
Open craniotomy
Brain surgery is an operation to treat problems in the brain and surrounding structures.
Read Article Now Book Mark Article - Endovascular repair (surgery), most often using a coil or coiling and stenting (mesh tubes), is a less invasive and more common way to treat aneurysms.
During aneurysm clipping:
- You are given general anesthesia and a breathing tube.
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark Article - Your scalp, skull, and the coverings of the brain are opened.
- Your brain is gently retracted to reach the aneurysm.
- A metal clip is placed at the base (neck) of the aneurysm to prevent it from breaking open (bursting).
During endovascular repair (surgery) 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 into and through the femoral artery and then guided through your arteries until it reaches the artery 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 and make sure the blood vessel stays open.
- During and right after the procedure, you may be given a blood thinner, such as heparin, clopidogrel, or aspirin. These medicines prevent dangerous blood clots from forming in the stent.
Why the Procedure Is Performed
If an aneurysm in the brain breaks open (ruptures), it is an emergency that needs medical treatment in a hospital. Often a rupture is treated with surgery, especially endovascular surgery.
A person may have an unruptured aneurysm without any symptoms. This kind of aneurysm may be found when an MRI or CT scan of the brain is done for another reason.
MRI
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark ArticleCT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark Article- Not all aneurysms need to be treated right away. Aneurysms that have never bled, especially if they are very small (less than 3 millimeters or 0.12 inch at their largest point), do not need to be treated right away. These very small aneurysms are less likely to rupture.
- Your surgeon will help you decide whether it is safer to have surgery to block off the aneurysm before it can break open or to monitor the aneurysm with repeated imaging until surgery becomes necessary. Some small aneurysms will never need surgery.
Risks
Risks of anesthesia and surgery in general are:
- Reactions to medicines
-
Breathing problems
Breathing problems
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Bleeding, blood clots, or infections
Risks of brain surgery are:
-
Blood clot or bleeding in or around the brain
Blood clot
Blood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...
Read Article Now Book Mark Article - Brain swelling
- Infection in the brain or parts around the brain, such as the skull or scalp
-
Seizures
Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
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Stroke
Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
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Surgery on any one area of the brain may cause problems that 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:
- Behavior changes
-
Confusion, memory problems
Confusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark Article -
Loss of balance or coordination
Loss of balance
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
Read Article Now Book Mark Article - Numbness
- Problems noticing things around you
- Speech problems
-
Vision problems (from blindness to problems with side vision)
Vision problems
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
Read Article Now Book Mark Article - Stroke-like symptoms such as muscle weakness on one side of the body
You may need another surgery to further treat the aneurysm or to treat a complication.
Before the Procedure
This procedure is often done as an emergency.
If it is not an emergency, tell your surgeon or nurse if:
- You are or could be pregnant
- You are taking any medicines, including medicines, supplements, or herbs you bought without a prescription
During the week before your surgery:
- You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Some other prescription medicines are also blood thinners.
- Ask your surgeon which medicines you should still take on the day of surgery.
On the day of surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- 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. If there is bleeding or other problems, such as narrowed blood vessels (vasospasm) in the brain or a buildup of fluid in the brain, the hospital stay can be 2 weeks, or longer.
Buildup of fluid in the brain
Hydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...
Read Article Now Book Mark ArticleYou will probably have imaging tests of the blood vessels (angiogram) in the brain before you are sent home, and possibly once a year for a few years.
Angiogram
An arteriogram is an imaging test that uses x-rays and a special dye to see inside the arteries. It can be used to view arteries in the heart, brain...
Read Article Now Book Mark ArticleFollow instructions on caring for yourself at home.
Caring for yourself at home
You had a brain aneurysm. An aneurysm is a weak area in the wall of an artery that bulges or balloons out. Once it reaches a certain size, it has a...
Read Article Now Book Mark ArticleAsk your surgeon if it will be safe for you to have imaging tests such as angiogram, CT angiogram, or MRI scans of the head in the future.
MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
Read Article Now Book Mark ArticleOutlook (Prognosis)
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, surgery 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 surgeon every year.
References
Altschul D, Vats T, Unda S. Endovascular treatment of brain aneurysms. In: Ambrosi PB, ed. New Insight Into Cerebrovascular Diseases - An Updated Comprehensive Review.www.intechopen.com/books/new-insight-into-cerebrovascular-diseases-an-updated-comprehensive-review/endovascular-treatment-of-brain-aneurysms. IntechOpen; 2020:chap: 11. Reviewed August 1, 2019. Accessed June 6, 2024.
American Stroke Association website. What you should know about cerebral aneurysms. www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds/what-you-should-know-about-cerebral-aneurysms#. Reviewed December 5, 2018. Accessed June 6, 2024.
Le Roux PD, Mack WJ, Winn HR. Surgical decision making for the treatment of intracranial aneurysms. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 427.
Levy ML, Levy DM, Manna B. Pediatric Cerebral Aneurysm. [Updated 2021 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; May 10, 2022. www.ncbi.nlm.nih.gov/books/NBK537085/. Updated August 8, 2023. Accessed June 6, 2024.
Macdonald RL. Perioperative management of subarachnoid hemorrhage. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 428.
Magiricu D, Garcia-Rybkin M. Isolated third nerve cranial palsy: complication of brain aneurysm. Surgical Science. 2024;15(4):225-231. www.scirp.org/journal/paperinformation?paperid=132665.
National Institute of Neurological Disorders and Stroke website. Cerebral aneurysms. www.ninds.nih.gov/health-information/disorders/cerebral-aneurysms. Updated November 28, 2023. Accessed June 6, 2024.
Review Date: 5/10/2024
Reviewed By: Luc Jasmin, MD, Ph.D., FRCS (C), FACS, Department of Neuroscience, Guam Regional Medical City, Guam; Department of Surgery, Johnson City Medical Center, TN; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.