Surgery for a Brain Aneurysm

Surgery for an aneurysm is performed as soon as possible. This is often within 72 hours of the diagnosis. Either open surgery or an endovascular procedure may be best. Treatment may not reverse any damage already done. The goal is to prevent further bleeding.

Open Surgery

The surgeon reaches the brain through the skull. First your loved one receives anesthesia to sleep during the surgery. Then, after a scalp incision, small holes are made in the skull. The bone between the holes is cut and lifted away. The dura is peeled back. Trapped blood and CSF may be removed. The surgeon closes off (clips) the aneurysm. 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 may be left in one of the small holes. This device measures pressure inside the skull.

Clipping the Aneurysm

The surgeon may put a clip on the aneurysm where it bulges from the artery. This keeps blood from entering the aneurysm. As a result, future bleeding is prevented and nearby brain tissue is protected from further damage. The surgeon makes sure that the clip is secure before finishing the surgery. This method, performed through open surgery, is considered the only true cure for a brain aneurysm.

Occlusion and Bypass

It may be best to stop blood flow through the artery leading to the 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 the 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 a specially trained doctor (interventional neuroradiologist). Anesthesia is given to block pain. Then a catheter is guided through the arteries from the groin to the brain. Platinum coils are released into the aneurysm. The coils cause a blood clot to form in the aneurysm, which seals it off. Although this is a very effective and less risky approach to treating aneurysms than open surgery, there is a slightly greater risk of the aneurysm reforming.