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Brain aneurysm repair

Definition

Brain aneurysm repair is a surgical procedure to correct an aneurysm, a weak area in a blood vessel wall that causes the blood vessel to bulge or balloon out and sometimes burst (rupture). It may cause: 

  • Bleeding into an area around the brain (also called a subarachnoid hemorrhage)
  • Bleeding in the brain that forms a collection of blood (hematoma)

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; Subarachnoid hemorrhage - aneurysm

Description

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

  • Clipping used to be the most common way to repair an aneurysm. This 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. It is now done in more than half of patients.

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 (neck) of the aneurysm to prevent it from breaking open (bursting).

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 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 small blood vessels in your brain where the aneurysm is located.
  • Thin metal wires or glue 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. Sometimes stents (mesh tubes) are also put in to hold the coils in place.
  • 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, 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. Aneurysms that have never bled and are very small (less than 7 mm at their largest point) do not need to be treated right away. These aneurysms 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:

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 brain and nervous system (neurological) problems include:

  • Behavior changes
  • Confusion
  • Loss of balance or coordination
  • Numbness
  • Problems noticing things around you
  • Speech problems
  • Vision problems (from blindness to problems with side vision)
  • 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 surgery for a bleeding aneurysm, it is uncommon for it to bleed again.

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

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

You may have more than one aneurysm. After endovascular treatment (coiling), you will need to be seen by your health care provider every year.

References

Bederson JB, Connolly ES Jr., Batjer HH, Dacey RG, Dion JE, Diringer MN, 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.

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.

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: Saunders Elsevier; 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;119:2235-2249.


Review Date: 7/19/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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