What is an Aneurysm Repair?
A brain aneurysm is an abnormal bulge in the wall of an artery in the brain. A brain aneurysm repair is surgery to control the aneurysm to prevent rupture and bleeding. Aneurysms occur at areas of thinning and weakness in the artery wall. They most frequently occur at forks in arteries at the base of the brain. They can also be called berry aneurysms because they frequently appear as the shape and size of a small berry. Most brain aneurysms produce no symptoms until they enlarge, start to leak blood, or burst. Should they burst they are a medical emergency and you should call 911 for transportation to the hospital. Fortunately, most brain aneurysms do not rupture and are detected from other tests for other conditions.
When do I need an Aneurysm Repair?
Unruptured brain aneurysms tend to have few or no symptoms. If they expand and press on nerves then they may have symptoms related to those nerves. These can include droopy eyelids, headaches, a dilated pupil, blurred vision or weakness.
Ruptured brain aneurysms are a life threatening medical emergency and you should call 911 for immediate medical care and transportation to the hospital. These will cause a subarachnoid hemorrhage which is bleeding into the space around the brain. Since the brain is in an enclosed space, the pressure inside of the head increases. Patients often describe this as “the worst headache of my life.” It can also cause confusion, loss of consciousness, a stiff neck, weakness, numbness, seizures, light sensitivity, nausea and vomiting.
A leaking brain aneurysm may allow a small amount of blood to escape called a “sentinel bleed”. This can also cause “the worst headache of my life” and symptoms in common with a rupture. In addition, rupture of the aneurysm can also follow this sentinel leak.
Emergency surgery is required for a leaking or ruptured brain aneurysm. For unruptured aneurysms the size, location and symptoms will help determine the likelihood of future rupture. In addition, the potential of injury from repair of a brain aneurysm needs to be considered in relation to the symptoms and chance of rupture.
Should a brain aneurysm be discovered on an unrelated imaging test, and you do not have related symptoms or risk factors, your doctor may recommend watchful waiting with regular imaging tests to ensure that the aneurysm does not grow over time. It is also important to stop smoking and to have your blood pressure well controlled. Should you develop symptoms it is important to get help immediately.
Most brain aneurysms are detected with testing for other conditions like headaches. Diagnosis may be suggested by a combination of a patient’s history and symptoms. MRI (Magnetic Resonance Imaging) and MRI (Magnetic Resonance Angiogram) are usually the tests of choice to detect unruptured brain aneurysms. These scans use strong magnetic fields and produce detailed soft tissue images of the brain.
How do I prepare for an Aneurysm Repair?
For emergency brain aneurysm bleeds, time is of the essence and emergency surgery is indicated. If the decision is made to operate on a non-emergent basis, your neurosurgeon will discuss the procedure with you including risks, benefits and alternative treatments. Your medications will be reviewed including herbal and over-the-counter drugs and supplements. Many herbal products and pain relievers make it harder for you blood to clot and should be discontinued before surgery. You will sign informed consents and get your instructions for before and for after surgery. You will see your own personal physician for a medical clearance to make sure they feel it is safe for you to have surgery. Your physician may order laboratory blood tests, an EKG or a chest X-ray. You need to stop smoking as this delays healing. You should have nothing to eat or drink after midnight before your procedure. You will be told when to arrive at the hospital before your surgery. You are signed in, change into a gown, given an IV, and will speak to the nurse and anesthesiologist. You will then talk to your neurosurgeon before you get any medication at the hospital so you can ask questions.
What happens during an Aneurysm Repair?
You are taken in to the operating room and the anesthesiologist will put you to sleep with a breathing tube to make sure your airway is safe. You will be placed on your stomach or back depending on the approach the neurosurgeon is using to your spine. The area to be operated on is sterilely prepared with a cleaning solution and drapes. A local anesthetic is injected to decrease bleeding and discomfort. The options for repair of an aneurysm are open repair and endovascular therapy.
Open surgical (microvascular) clipping:
A small opening in your skull or skull base is made to provide access to the brain aneurysm. Micro instruments are used to attach metal clips to seal off the base of the aneurysm. This stops blood from flowing into the aneurysm and will stop brain bleeding and prevent future rupture of the aneurysm. Recovery time may be a few weeks for unruptured aneurysms with longer times of up to a few months for ruptured aneurysms. Aneurysm surgery is considered curative although aneurysms may recur.
Endovascular therapy which includes coil embolization, stenting, balloon remodeling, flow diversion, or an intraluminal “Web” device:
Sometimes it is possible to treat a brain aneurysm through a catheter in the arm or groin. The catheter is threaded through the vessel to the area of the aneurysm. Using balloons or stents, wires are used to coil inside of the aneurysm. An intraluminal Web device is a mesh ball that can also be placed in the aneurysm. Both techniques form blood clot formation to block blood flow into the aneurysm. Flow diversion uses a similar catheter to place a mesh tube in the part of the blood vessel that contains the aneurysm. The tube acts as a stent to bypass the aneurysm.
After your procedure, you are taken to the waiting room and watched to make sure you are recovering from anesthesia well. Your nerve function will be checked. If you required a minimally invasive procedure you may go home the same day. If not, you will be admitted overnight will normally have a 1 to 5 day hospital stay.
What is the follow-up for an Aneurysm Repair?
You can either take pain medicine the doctor has given you or acetaminophen. If you need a narcotic pain medicine they should be taken with food in your stomach and you should start on a mild stool softener like Senna. If you have any loss of movement you will start physical therapy to maximize function. A physical therapist will work with you to ensure that you are stretching and exerting yourself appropriately. Your doctor will let you know what level of activity you can resume. Call your doctor if you have increasing redness of the incision, fever, bleeding, pus, drainage, change in consciousness, the incision opens or you have worsening pain. Also, let your doctor know if you have any other concerns.
What are the Risks for an Aneurysm Repair?
All surgeries have potential risks. The general anesthetic to completely put you to sleep has risks which the anesthesiologist will discuss with you. Risks of the surgical procedure may occur. You might have bleeding, blood clots or infection of the aneurysm or incision. You could have poor wound healing. The brain may be injured during the procedure or may not recover function or sensation lost before the procedure. You may have brain swelling or strokes. There are arteries and veins during the approach that may be injured. You may have a leak of the fluid surrounding the brain, a CSF leak.
The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of brain aneurysms. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us or call our office 212-444-8006.