Brain aneurysm surgery is a lifesaving medical procedure that attempts to repair a bulging, weakened area in the wall of a brain artery.

A brain aneurysm is a balloon-like bulge in an artery in the brain. If it bursts, it can lead to severe bleeding and, potentially, a life threatening hemorrhagic stroke.

Brain aneurysm surgery addresses aneurysms before they rupture or repairs the damage due to a rupture. Surgery involves placing a clip at the base of the aneurysm to stop blood flow or inserting coils to promote blood clotting within the aneurysm. The procedure prevents catastrophic bleeding and relieves symptoms due to the pressure the aneurysm exerts on surrounding brain tissue.

The recovery process includes:

  • intensive monitoring
  • gradual reintroduction to daily activities
  • ongoing support to help the person regain independence and prevent future complications

This article explores brain aneurysm surgery, the procedure, recovery, and outlook.

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A brain or cerebral aneurysm is a bulge or ballooning in a blood vessel in the brain. It occurs when a weakened part of the blood vessel wall fills with blood, creating a swelling that resembles a balloon.

Brain aneurysms can develop anywhere in the brain but most commonly occur at the base of the brain, where the major blood vessels branch off.

Most brain aneurysms do not cause symptoms and go unnoticed. However, if an aneurysm grows large enough, it can place pressure on the surrounding brain tissue and nerves, potentially causing headaches, blurred vision, and pain above or behind the eye.

The most serious risk relating to a brain aneurysm is its potential to rupture and cause a hemorrhagic stroke. This rupture can result in severe brain damage, neurological problems, or, without prompt treatment, death.

Learn more about brain aneurysm.

There are two main types of brain aneurysm surgery.

  1. Endovascular coiling: This minimally invasive procedure is the most common treatment option. It involves inserting a catheter through an artery in the groin and threading it up to the brain aneurysm. The surgeon then deploys tiny platinum coils into the aneurysm, inducing clotting and sealing off the aneurysm from blood flow.
  2. Surgical clipping: This surgery requires general anesthesia. In this procedure, a neurosurgeon places a small metal clip at the base of the aneurysm to stop blood flow and prevent it from rupturing. This method requires an open craniotomy, where a surgeon removes a section of the skull to access the brain. Eventually, the aneurysm shrinks and scars, but the clip remains for life.

Preparing for brain aneurysm surgery involves several steps:

  • Medical evaluation: The healthcare team performs a comprehensive assessment. Imaging tests, such as MRIs, CT scans, or angiographies, help determine the aneurysm’s size, location, and risk of rupture.
  • Medications: Before surgery, people may need to stop certain medications, such as blood thinners. Healthcare professionals may also prescribe medications to control blood pressure or prevent seizures.
  • Fasting: Individuals must typically fast overnight or several hours before the procedure.
  • Preoperative instructions: The healthcare team provides detailed instructions on what to expect during and after the surgery, including postoperative care and recovery guidelines.

The exact process depends on the procedure.

Here’s what to expect during endovascular surgery:

  • Sedation: The anesthesiologist administers sedation or general anesthesia.
  • Disinfection: Nurses scrub and shave the groin area and then prepare the area with sterile drapes.
  • Surgery: The surgeon makes a small skin incision approximately 6 millimeters over the artery. They then place a sheath in the artery for continuous access. They insert and guide a catheter to the aneurysm site using X-ray visualization. Next, they advance a microcatheter into the aneurysm and introduce the coil system or flow diversion device.

The procedure for surgery differs slightly:

  • Sedation: The anesthesiologist administers general anesthesia.
  • Disinfection: Nurses scrub and shave the area of the skull and then prepare the area with sterile drapes.
  • Surgery: These are the procedures relating to the surgery:
    • The neurosurgeon makes an incision behind the hairline or on the back of the head, depending on the aneurysm’s location.
    • They remove a section of bone from the skull, using a procedure known as a craniotomy, to expose the brain tissue.
    • Next, they approach the aneurysm in the opening between the skull and the brain without going through brain tissue.
    • They use a microscope to separate the aneurysm from typical blood vessels and brain tissue.
    • They then clip the aneurysm with a device resembling a tiny clothespin, sealing it completely to prevent blood flow.
  • Closure: They secure the bone plate back in place and close the wound.

Aftercare and recovery from brain aneurysm surgery involve:

  • Hospital stay: The healthcare team monitors the individual after surgery. People typically stay in the hospital overnight for the endovascular procedure and up to 1 week following surgery. However, if the treated aneurysm has ruptured, they may be in the hospital for 2 weeks. This allows the team to monitor the person for complications such as bleeding, stroke, or infection.
  • Medications: Doctors may prescribe pain management medications, anticoagulants, and medications to prevent blood vessel narrowing, known as vasospasm.
  • Activity restrictions: Recovery at home may take up to 6 weeks. During this time, the person should perform only limited physical activity to avoid strain on the surgical site and reduce the risk of complications.
  • Follow-up: Regular follow-up appointments to monitor recovery and ensure the aneurysm has undergone effective treatment. People may require imaging tests to confirm the coil’s stability for the endovascular procedure.
  • Rehabilitation: Depending on the surgery’s effects, people may require physical therapy, occupational therapy, or speech therapy to regain typical function.

The outlook after brain aneurysm surgery varies according to the aneurysm’s size, location, and whether it has ruptured. No matter the treatment, the postsurgery mortality rate is significantly lower for unruptured aneurysms.

Early detection and treatment improve outcomes significantly. While recovery can be lengthy and may involve rehabilitation, many people can return to their usual activities with time.

Long-term monitoring is essential to ensure no new aneurysms develop and manage potential complications.

Brain aneurysm surgery involves either clipping or endovascular coiling. It is a critical procedure to prevent or treat a ruptured aneurysm. Surgery performed before an aneurysm rupture generally has more positive outcomes.

Timely intervention and appropriate treatment can significantly improve a person’s outlook and reduce the risk of severe complications.