Brain aneurysm refers to weakening of the wall of an artery that supplies blood to brain. In most of the cases it is asymptomatic but the weakened artery may bulge & rupture causing stroke, brain damage and death. Bleeding caused around the brain is called as subarachnoid hemorrhage.Brain aneurysm surgery is a procedure to repair the bulging/ballooning blood vessel which is at the risk of rupturing.
Brain aneurysm surgery is indicated when it is detected that the weakened artery wall is likely to rupture and when the risk is significant.
Patients with aneurysms larger than three millimeters, those having high blood pressure, those with aneurysm located on larger blood vessel and those with family history of aneurysm rupture are at greater risk and require preventative surgery.
An aneurysm is often detected when some other conditioned is being investigated using CT scan or MRI scanning. Since it is usually done on emergency basis, there is no time for preparation.
When risk of rupture is low, regular monitoring and lifestyle changes are recommended.
The surgery is performed by a neurosurgeon mostly under general anesthesia. 2 techniques that mainly used are neurosurgical clipping and endovascular coiling:
Neurosurgical clipping: a cut is made in the scalp and a small flap of bone is removed to access the brain. The aneurysm is located and a metal clip is permanently clamped at the base of the aneurysm where it arises from the blood vessel. The bone flap is then placed back and the scalp is sutured / stapled.
Endovascular coiling: a small cut is made in the groin and a catheter is inserted into a blood vessel which is then navigated to the vessels of the brain and then to the aneurysm. Through the catheter, metal wire is inserted which coils into a ball in the aneurysm up to the base of the aneurysm from where it arises from the vessel. This prevents rupturing of the aneurysm. A stent may be needed to keep the coil in place.
Clipping procedure can take up to 4 hours and coiling procedure can take 2-3 hours.
Patients with severe subarachnoid hemorrhage may need hospitalization up to a month.
Neurosurgical clipping is an invasive technique and it takes much longer time to recover when this technique is used over endovascular coiling.
Risk and Complications
There is risk of infection, formation of blood clots, brain swelling, behavioral changes, seizures and stroke.
Patient’s memory and motor coordination may also be affected.
There is also risk of reaction to anesthetic medications.
Brain aneurysm surgery is not preferred in very old patients as the risk is higher.
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