Surgery for a Brain Aneurysm

Surgery is performed to prevent an aneurysm from bleeding. Surgery for an aneurysm is done as soon as possible if it has just bled. It is usually not urgent if the aneurysm has not bled. There are two types of procedures done for brain aneurysms: open surgery or an endovascular procedure. In open surgery, a portion of your skull is removed. In an endovascular procedure, your surgeon goes through the blood vessel leading toward your aneurysm. Treatment may not reverse any damage already done if the aneurysm has ruptured, but it reduces any further damage.

Open surgery

In open surgery, the surgeon reaches your brain by opening your skull. You will receive medicine (anesthesia) to make you sleep. Then after a scalp incision is made, small holes are made in your skull. The bone between the holes is cut and lifted away. The membrane that surrounds your brain (dura) is peeled back. Trapped blood and cerebrospinal fluid may be removed. Then the aneurysm is closed off (clipped), or the artery leading to the aneurysm is sealed off (occluded). The dura and the piece of skull are put back in place. A device that measures the pressure inside your skull or that drains your spinal fluid may be left in one of the small holes.

Clipping the aneurysm

Your surgeon may put a clip on your aneurysm where it bulges from the artery. This keeps blood from going into the aneurysm. As a result, future bleeding is stopped and nearby brain tissue is protected from more damage. Your surgeon makes sure that the clip is secure before finishing the surgery. This method is done through open surgery.

Occlusion and bypass

It may be best to stop blood flow through the artery leading to your aneurysm. This is called occlusion. In most cases, it is done as open surgery. Sometimes occlusion is combined with a bypass. A bypass reroutes blood around the occlusion. It brings the blood to the part of your brain that had been fed by the damaged artery. A small blood vessel is used for the bypass.

Endovascular procedure

An endovascular procedure may be best for some aneurysms. This is done in an X-ray lab by specially trained doctors such as an interventional neuroradiologist, neurosurgeon, and neurologist. Anesthesia (numbing medicine) is given to block pain. Then a small tube (catheter) is guided through the arteries from your groin to your brain. Coils are threaded into your aneurysm. The coils cause a blood clot to form in your aneurysm. This seals it off. This is a very effective and less risky way to treat aneurysms than open surgery. There is a slightly greater risk that the aneurysm will re-form when compared to clipping. Not all aneurysms can be treated by an endovascular approach.