Introduction
Aneurysm clipping is a surgical treatment for brain aneurysms that involves placing a metal (generally titanium) 'clip' on the 'neck' of the aneurysm - the section of the aneurysm connecting to the blood vessel it arises from. This prevents the aneurysm from rupturing by stopping blood from flowing into the aneurysm itself. Once the aneurysm clip is in place, it stays permanently inside the head, while the aneurysm gradually shrinks and the blood vessel adjacent to the aneurysm remains open.
Preoperative Instructions
Before all neurosurgical procedures, including the procedure for aneurysm clipping, you will be given instructions to…
- Not have any food or drink from midnight before the procedure, although medications can be taken with small sips of water.
- Advise our office if you take blood thinning medications because you will need to stop taking such medications before the procedure. Your doctor will inform you when and how to stop these.
- If possible, avoid any non-steroidal anti-inflammatory medication (NSAIDs) one week ahead of the procedure.
- Also, avoid having dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure.
- If you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection in the few days before your operation, please let our office know as soon as possible to reschedule your procedure.
Procedure
This procedure is carried out under general anaesthesia. The surgeon makes an incision, normally this is on the head behind the forehead and above the hairline. A segment of bone is removed using a high-speed burr (a specialised type of medical drill) and a small medical saw (a 'craniotome'), the outer covering of the brain (the 'dura') is opened and the aneurysm is approached in the natural spaces or anatomical divisions (‘fissures’) between the parts of the brain (‘lobes’) to avoid damage through brain tissue. Using an operative microscope, the aneurysm itself is gently lifted away from the blood vessel and an aneurysm clip is placed over the base of the aneurysm. Once this is completed, the removed section of skull bone is returned and secured using small metal plates and screws. This procedure generally takes 3-5 hours to complete.
Postoperative Instructions
Where the aneurysm is unruptured, most patients are able to leave hospital after a few days. Where the aneurysm had ruptured prior to surgery, the hospital stay is generally longer, of the order of 2-3 weeks, to monitor for complications of the aneurysm rupture (‘subarachnoid haemorrhage’) and expected longer recovery.
Risks
In addition to the standard risks of surgery and general anaesthesia, the following are potential risks associated with this procedure…
- Stroke, leading to weakness, numbness, visual and speech changes.
- Aneurysm rupture during surgery.
- Seizure.
- Bleeding.
- Positioning of clip (which may either not close off the aneurysm completely or block another blood vessel).
- Brain swelling.
- Effects of subarachnoid haemorrhage / ruptured aneurysm: Vasospasm (narrowing of an artery) and Hydrocephalus (excessive build-up of cerebrospinal fluid).
Please Note: As most modern aneurysm clips (and plates and screws) are made of titanium, they are usually compatible with MRI (magnetic resonance imaging) scans. However, it is very important - if you have clips / plates / screws in place - to check if these are compatible with MRI before having a scan. You can check these details from records held at the hospital where you had the original surgery.