Why is this surgery done?
In many instances, an aneurysm is found unexpectedly on a brain imaging study that is being done for another reason. An aneurysm is an abnormal, sac-like pouch that develops from the wall of a brain artery. The risk in having an aneurysm is that it can burst and produce bleeding in or around the brain.
If you have a brain aneurysm detected on an imaging study, your healthcare providers will look at factors such as the size, shape and location of your aneurysm, which may affect its risk for bleeding. They will also take into consideration your age, general health, family history and the risks associated with treatment. They will recommend whether you should consider surgery or another form of treatment.
If an aneurysm bleeds, most patients will be extremely ill. Once it has bled, the risk that it will bleed again is quite high. Treatment is often recommended right away to prevent another bleed. Again, in this instance, your healthcare providers will recommend the best treatment option for you.
How is aneurysm clipping/reconstruction done?
Your surgery will be done using a general anesthetic. A small strip of your hair will be shaved over the area of the planned incision. Most often, this is just behind your hairline. A window is made in your bone. It is replaced at the end of surgery. Aneurysms occur in common locations on the arteries that course over the surface of your brain. Surgery usually takes place in the spinal fluid space between your skull and brain surface. Using a very high-powered surgical microscope, an aneurysm clip is placed across the bottom of your aneurysm to seal it. This keeps it from filling with blood, and it reforms the wall of the artery. The aneurysm clip resembles a miniature clothespin. It is usually made of titanium so it will not interfere with any future brain scans such as a CT or MRI .
What are my risks? What are common complications?
There are several factors your healthcare providers review to try to determine the risk of your individual aneurysm bleeding. The good news is that the risk is often low on a yearly basis. The bad news is that if an aneurysm does indeed bleed, there is a risk to life and the possibility of permanent neurological injury.
Surgery also has some risks. Like with any operation, there is a small risk for such things as infection, blood clot or even death. The risk specifically associated with this surgery is related to the fact that the operation is being performed on an artery that supplies blood to your brain. If there is a problem, this could lead to a stroke. Fortunately, such problems are not common.
Your healthcare providers will discuss the balance between a lifelong risk from a low daily chance of the aneurysm bleeding versus a higher one-day risk associated with surgery. They will give you their best recommendation, but the decision will depend on how you feel most comfortable proceeding.
In the event that your aneurysm has bled, treatment is almost always recommended to prevent the very high risk that it will bleed again. Many of the risks and complications are associated with the bleed itself.
What do I need to know before surgery?
Don’t be surprised if you feel really nervous. This is typical for most patients who are looking at a major surgery. Your surgery is often planned based on your CT angiogram study. Occasionally, a formal angiogram study is also needed. You will be asked to undergo a preoperative medical assessment to make sure you are in optimal condition for anesthesia and your surgery.
It is a good idea to bathe and shampoo before your surgery. You will be asked to stop eating usually about eight hours, and to drink only clear liquids up to two hours, before your surgery. Check with your healthcare provider about taking your medicines before surgery. Follow any additional instructions you are given.
For an elective surgery, you will arrive at the hospital with your family or a close friend several hours before your operation. Surgery takes 3 – 4 hours or more. Your surgeon will usually give you an estimate of the time it might take. Following surgery, you will go the recovery room or directly to the intensive care unit (ICU), where you will be watched overnight. Often, a CT scan is done the following morning. You can usually expect to stay in the hospital over 2 – 3 nights barring any unexpected problems. A post-operative CT angiogram or formal angiogram may be checked before you leave the hospital.
If your aneurysm has bled, your family can anticipate that you will be in the hospital for 7 – 14 days or longer. Many of these days will be in the ICU. There are several issues which may occur as a result of the hemorrhage from your aneurysm that lead to the longer stay.
General discharge instructions
An anti-seizure medication may be used as a precaution during the first seven days following your operation.
- Do not drive a car, use dangerous machinery, perform vigorous exercise or return to work until you are cleared by your surgeon.
- Use common sense. Try to maintain some level of activity. This is better than staying in bed. Walking is generally a good idea, but don’t overdo it.
- Wear a loose hat or head covering to keep sun off your incision for several months.
- Don’t scratch your incision. You may use a gentle shampoo and clean it gently using the palm of your hand.
- Avoid alcohol and recreational drugs.
- Do not smoke. Smoking can delay healing and may contribute to postoperative infection.
- Try to maintain a regular sleep schedule.
- Pay attention to good hydration and nutrition.
- Use stool softeners if needed.
When to call:
- Fever of 101°F or higher
- Wound drainage, redness or swelling at the incision site
- Severe headache not controlled by pain medicine
- Headache associated with vomiting, neck stiffness or light sensitivity
- Confusion, trouble speaking or moving, or any type of seizure activity
What should I expect while recovering?
When you are awake, you will usually resume a regular diet. You may have a mild sore throat from the breathing tube used during your general anesthesia. You most likely will get out of bed and sit in a chair the morning following your operation. Your urinary catheter and some of your IVs or monitoring lines will be removed. You may then start walking. Early on, the nurses will instruct you and be with you for any activity. You will usually transfer out of the ICU to a regular room within 1 – 2 days of your surgery.
If a small surgical drain is placed under the scalp, it is removed within 1 – 2 days. If the incision is just behind your hairline, you may develop some swelling of your eyelid, which may last for a few days after the drain is removed. You may also experience some soreness in the area where your jaw hinges when you try to open your mouth widely. This occurs because the jaw muscle is moved during surgery. Keep using it. It will get better. Your surgical staples or sutures are usually left in place for 7 – 14 days.
You may have discomfort in your incision region, and you may have some headache. It usually is not severe. Medicine will be available to help if you need it. An area of your scalp may feel numb. This usually fades away over several months.
Following general anesthesia and surgery, you can expect to feel fatigued or tired in the first week to month following your discharge. Your surgeon will limit activity as outlined in your discharge instructions.
If you had surgery because your aneurysm bled, your treatment process and recovery will mostly be dictated by the effects of the hemorrhage.