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CRANIOTOMY & CLIPPING OF CEREBRAL ANEURYSM

The options for treatment of a cerebral aneurysm include:

• Endovascular interventions ie coiling, stenting, glueing

• Operative intervention and clipping of the cerebral aneurysm

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OPERATIONS

Craniotomy & clipping of cerebral aneurysm
The neurosurgical treatment of an aneurysm involves the patient being put to sleep with a general anaesthetic.  A curved incision and a bone window is created (craniotomy).  A microscope is used to carefully identify the aneurysm and a permanent metallic clip is surgically placed across its neck, securing the aneurysm from further bleeding in the future.  A ventricular drain may be inserted.  Any associated blood clot is removed if safe and the bone is replaced with rivets and the patient awoken.  If a subarachnoid haemorrhage has occurred often patients will require a two-week hospital stay ensuring a safe recovery.

Intravascular treatment of cerebral aneurysm
This procedure is performed by the neuroradiologist following discussion with the neurosurgeon.  It is the essentially the same procedure as a digital subtraction angiogram however a general anaesthetic is required.  A thin catheter and guidewire are passed upwards through the arteries to the base of the aneurysm.  Several options are then possible including:

- Coiling
- Gluing
- Stenting

The procedure will take several hours.  Depending on what option is used you may be required to continue taking blood thinning medication like asprin or plavix  for a period of time.  The neuroradiologist will discuss this with you.  Several monitoring angiograms will also be required following this procedure.  Occasionally the aneurysm neck may reform requiring a second procedure or operation.

Risks of this procedure:

The risks of this operation includes the following.  A detailed discussion with your surgeon is recommended prior to surgery.

• Infection – superficial wound infection or deeper infections including meningitis, osteomyelitis

• Bleeding – which may be superficial or deep causing intracerebral haematoma and stroke-like symptoms such as weakness, numbness and speech disturbance

• Epilepsy which may require medication

• Permanent neurological damage in the form of weakness, numbness, paralysis (stroke like symptoms)

• Cognitive impairment,which may include subtle changes in personality, memory & thought processing.

• Hydrocephalus – which may be temporary or permanent and may require a second operation.

• Loss of vision or double vision.

• Loss of smell or cerebrospinal fluid leak through the nose if a frontal approach is required.

• The need for a blood transfusion during or after the procedure.

• Coma and death

Treatment of a ruptured cerebral aneurysm usually occurs in a rapid manner due to the risk of the aneurysm rebleeding.  In cases where the patient is in a poor grade SAH early intervention gives the best chance of any recovery.

For more information, see: Conditions: Cerebral Aneurysm

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