Brain aneurysm repair

Definition

Brain aneurysm repair is a surgical procedure to correct an aneurysm, a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. It can leak blood and cause a stroke or bleeding into an area around the brain (also called a subarachnoid hemorrhage).

See also: Aneurysm in the brain

Alternative Names

Aneurysm repair - cerebral; Cerebral aneurysm repair; Coiling; Saccular aneurysm repair; Berry aneurysm repair; Fusiform aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain

Description

You and your doctor will decide the best way to perform surgery on your aneurysm. There are two common methods used to repair an aneurysm:

• Clipping is the most common way to repair an aneurysm. This is done during an open craniotomy. See also: Brain surgery (craniotomy)
• Endovascular repair, most often using a "coil" or coiling, 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 up.
• A metal clip is placed at the base of the aneurysm to prevent it from breaking open (rupturing).

During endovascular repair of an aneurysm:

• The procedure is usually done in the radiology section of the hospital.
• You may have general anesthesia and a breathing tube. Or, you may be given medication 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 small blood vessels in your brain where the aneurysm is.
• Thin metal wires are put into the aneurysm. They then coil up into a mesh ball. Blood clots that form around this coil prevent the aneurysm from breaking open and bleeding.
• During and right after this procedure, you may be given a blood thinner called heparin.

Why the Procedure Is Performed

If an aneurysm in the brain ruptures, it is an emergency that needs medical treatment, and often surgery. Endovascular repair is more often used when this happens.

A person may have an aneurysm but have no symptoms. This kind of aneurysm may be found when an MRI or CT scan of the brain is done for another reason.

• Not all aneurysms need to be treated right away. Those that are very small (less than 3 mm) are less likely to break open.
• Your doctor will help you decide whether it is safer to have surgery to block off the aneurysm before it can break open (rupture).

Risks

Risks for any anesthesia are:

• Breathing problems
• Reactions to medications

Possible 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
• Seizures
• Stroke
• 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, and they may last a short while or they may not go away.

Signs of neurological problems include:

• Behavior changes
• Confusion
• Loss of balance or coordination
• Numbness
• Problems noticing things around you
• Speech problems
• Vision problems (from blindness to peripheral vision problems)
• Weakness

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 day of the surgery.
• Always try to stop smoking.
• You will usually 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.

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 beforehand.

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 more.

You will probably have an x-ray test of the blood vessels in the brain (angiogram) before you are sent home.

Ask your doctor if it will be safe for you to have MRI scans in the future.

Outlook (Prognosis)

After successful surgical treatment for a bleeding aneurysm, it is uncommon for it to bleed again.

The outlook also depends on any brain damage that occurred from bleeding before, during, or after the surgery.

Most of the time, open surgery or endovascular repair is more likely to prevent a brain aneurysm that has not caused symptoms from becoming larger and breaking open.

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References

Brinjikji w, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke. 2010;41:116-121.

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;119:2235-2249.

Patterson JT, Hanbali F, Franklin RL, Nauta HJW. Neurosurgey. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 72.