Operations to treat brain aneurysms

A brain aneurysm is the dilation of a blood vessel in the brain. It must be surgically treated, as it can lead to a brain haemorrhage. Cerebral aneurysms are closed using either a clip (clipping) or coils (coiling).

Abnormalities in the brain’s blood vessels can lead to serious brain haemorrhages. Cerebral aneurysms are one such abnormality. A section of the brain’s arteries becomes dilated – often a branch of one of the larger brain arteries. Cerebral aneurysms usually do not cause any symptoms until they burst, so they are often only identified once haemorrhaging has occurred. Occasionally aneurysms are discovered by accident during MRI examinations of the brain. There are two surgical techniques used to treat aneurysms: clipping and coiling. The choice of procedure is primarily determined by the size and shape of the aneurysm. The most common sack-shaped aneurysms are usually treated using endovascular coiling. The clipping procedure is used for more complex aneurysms.

Aneurysm clipping

During this procedure the dilated vessel is closed using a clip, cutting it off from the blood circulation.

What preparations are carried out before the procedure?

Before the operation the patient must undergo various examinations to determine the location and extent of the aneurysm, including an angiogram, CT and MRI scans.

All the usual pre-operative assessments are also required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. The patient is usually admitted to the hospital on the day before the operation, unless it is an emergency. They should have an empty stomach when they go into surgery.

How is the operation performed?

Aneurysm clipping is performed under general anaesthetic. First an incision is made in the skin, then a precise section of the skull is opened. This microsurgical procedure involves the use of a microscope, which makes it possible to effectively illuminate and magnify the area being operated on. The microscope enables doctors to identify even the smallest structures and perform the procedure with minimal damage to the surrounding tissue. The aneurysm is closed from the outside using one or more clips, thereby eliminating the risk of a rupture. The procedure can take between three and six hours, depending on the location and complexity of the aneurysm.

What is the success rate of this procedure?

The clipping method has a good success rate. This surgery permanently closes the aneurysm.

What are the possible complications and risks of this procedure?

Even though this is a microsurgical procedure involving minimal damage to the surrounding tissue, the risks and possible complications should not be overlooked. The aneurysm can rupture during the operation and the procedure can lead to circulatory disorders and strokes.

What happens after the operation?

After the operation various examinations are carried out to check the circulation within the brain. The patient should avoid any strenuous activities for three months, but after that it is possible to lead a normal life.

Endovascular coiling

The coiling procedure involves closing the aneurysm from inside the blood vessel by inserting tiny platinum coils through an endovascular access point.

What preparations are carried out before the procedure?

Before the operation the patient must undergo various examinations to determine the location and extent of the aneurysm, including an angiogram, CT and MRI scans.

All the usual pre-operative assessments are also required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. The patient is usually admitted to hospital on the day before the procedure. They should have an empty stomach when they go into surgery.

How is the operation performed?

Endovascular coiling is performed under general anaesthetic. The microcatheter used to position the platinum coils is usually inserted through the femoral artery in the groin. Fluoroscopic imaging is used to monitor the catheter as it is pushed through the artery until it reaches the brain aneurysm. The coils are then used to close the aneurysm. Sometimes a balloon or a stent is also used to help fix the coils in place.

What is the success rate of this procedure?

The success rate of brain aneurysm operations using the coiling procedure is not quite as good as those with the clipping method. In around 30% of patients the coiling does not completely close the aneurysm and a second coiling must be performed.

What are the possible complications and risks of this procedure?

The risks and complication rates are lower than with clipping, because the operation is carried out through a vascular access point. The operation is therefore less likely to adversely affect the brain.

What happens after the operation?

After the operation various examinations are carried out to check the circulation within the brain. Check-ups are required later on to see if the coils are working properly. The patient should avoid any strenuous activities for three months, but after that it is possible to lead a normal life.