If you or someone you know has been diagnosed with a brain aneurysm, your surgeon may have recommended a surgical procedure to prevent the aneurysm from rupturing and potentially causing dangerous bleeding within the brain.
Clipping and coiling are two of the most common procedures used to treat an unruptured brain aneurysm. Both are effective ways to prevent rupture by keeping the blood from flowing into the aneurysm, and your surgeon may recommend one or the other depending upon your particular case and individual needs. Because the surgeries themselves are different, your brain aneurysm surgery recovery will also vary depending on the procedure, as well as your individual situation.
What Is a Brain Aneurysm?
An aneurysm is a damaged or weakened area in the wall of an artery that supplies blood to the brain. This weak area balloons out, creating a sac that fills with blood. Some aneurysms remain small and cause no symptoms, but an aneurysm can enlarge, putting pressure on the brain and causing symptoms such as headaches, double vision, or pain above and behind the eye.
Enlarged aneurysms can begin to bleed slowly, but more frequently an aneurysm unsuspectingly bursts— an event called a subarachnoid hemorrhage, or stroke. While the majority of people with an aneurysm will never experience a burst, a ruptured aneurysm is a medical emergency, and prompt treatment can save lives and minimize long-term neurological problems.
Aneurysms can have a number of causes. Heredity may play a role, and so can atherosclerosis, or “hardening of the arteries,” and abnormalities at the junctions where blood vessels come together. Some are caused by infections of the artery wall. Although some aneurysms can be managed by taking care of an underlying condition with medication or lifestyle changes, your doctors may determine that either clipping surgery or a coiling procedure can offer the best option for resolving your aneurysm.
Clipping Vs. Coiling: Effective Options for Treating Aneurysms
Clipping
Aneurysm clipping is an established procedure for treating both unruptured and ruptured aneurysms of various shapes and sizes by placing a metal clip directly across the aneurysm neck, or stem. This closes off the aneurysm sac so that no more blood can flow into it. Over time, the sac shrinks and disappears.
Clipping is generally safe and effective, but it is an invasive surgical procedure that requires general anesthesia and a craniotomy to open the skull and access the brain. If your aneurysm had not ruptured, you can expect a hospital stay of three to five days. At home, recovery typically takes about three to six weeks. If you experienced a ruptured aneurysm, you may remain in the hospital for two to three weeks or more while your medical team monitors you for problems arising from the rupture.
Coiling
Aneurysm coiling is a relatively new alternative to clipping surgery that is less invasive and has a shorter recovery time. Coiling is an endovascular procedure that requires only an incision into the femoral artery in the leg. Through this artery, surgeons direct a microcatheter to the aneurysm site and fill the sac with fine metal coils so that no more blood can flow into it.
Like clipping, coiling requires general anesthesia, but without complications, your stay in the hospital may be only a day or two, and you can expect to resume most normal activities within about a week.
Is Clipping or Coiling Right For You?
Aneurysm clipping and coiling are effective and relatively safe options for resolving an aneurysm, but they aren’t equally appropriate for everyone. To determine which procedure is right for you, your doctors will consider a variety of factors, such as your age, overall health condition and the circumstances surrounding your aneurysm.
Because clipping surgery is an invasive procedure with a relatively long recovery time, it may not be appropriate for older, frailer people or for those with chronic health problems. But clipping can treat a wide variety of aneurysm types, and it can resolve an aneurysm with minimal chance for recurrence.
Coiling is minimally invasive, so it can be a safer choice for older patients and those with ongoing health concerns. This procedure can also treat aneurysms in locations that are difficult to access for clipping. But coiling may not be effective for aneurysms of certain shapes and sizes.
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Brain Aneurysm Surgery Recovery
Recovery From a Clipping Procedure
If you choose to have a clipping procedure to treat your brain aneurysm, your surgeon will put you under general anesthesia and will perform what is referred to as an open surgery. This means that the surgeon makes an incision and directly accesses the blood vessel in order to clip the aneurysm, as opposed to accessing it by following the blood vessels (discussed later.)
A patient who has a brain aneurysm clipping procedure performed in a non-emergency situation can expect to spend from two to five days in the hospital after the surgery. This ensures that doctors can monitor you and evaluate the success of the procedure. You will be able to walk around within about a day, dependant upon your doctor’s advice.
There are sometimes factors that can complicate a case, such as your current state of health, medications and the severity of your particular condition, which might lengthen your stay. Clipping performed in an emergency situation on a ruptured aneurysm can result in a hospital stay of three to four weeks due to the careful monitoring required in such a case.
Because clipping involves a surgeon making an incision into the skull, you may have sutures (stitches) closing the incision site, which also need time to heal. Stitches will usually be removed after approximately 10 days, though some surgeons use material that will dissolve on its own. Your physician will give you individually tailored instructions, but you will typically be able to resume washing your hair once your sutures are out, be able to submerge your head or swim within weeks and dye your hair within months.
As far as daily activities, what your doctor recommends will depend upon your individual situation. However, in general, you can expect to be out of work for a few weeks while you recover. You may find that you are often tired and will likely be on pain-reducing medication, so your body will need time to rest and heal. Similarly, you will probably be advised not to drive for two to three weeks and to avoid strenuous exercise and/or contact sports for three months or more.
Recovery From a Coiling Procedure
For some patients, your neurosurgeon will recommend you undergo a coiling procedure. Coiling is endovascular, meaning that the surgeon accesses the aneurysm by navigating through the blood vessels of your body. In this procedure, the surgeon will enter via your leg, rather than through the skull.
If you undergo coiling, you can expect your brain aneurysm recovery time to be slightly shorter, provided there are not complications and you are admitted in a non-emergency situation. You will typically only spend a day or two in the hospital for monitoring, but the first six to 24 hours of that will require you to lay flat on your back in your bed. Patients whose aneurysms have ruptured may spend in the range of three weeks in a hospital setting, depending upon the circumstances.
Once you are discharged, you can expect to spend from three to seven days under restrictions. Your doctor will give you specific instructions depending upon your situation, but you will likely be home from work for about a week, with instructions to avoid driving or lifting anything heavier than 10 pounds for three days and to be sure to drink plenty of water in order to flush out the dye from the procedure.
Within approximately a week, you will be able to resume all of your normal daily activities, as advised by your physician. You will likely take pain-reducing medications after your surgery, but your doctor may also recommend you take a blood-thinning prescription following your coiling procedure.
Each Patient Is Different
While these general guidelines hold true for many patients, the fact is that every patient is different. Your age, health status, size of your aneurysm, location of your aneurysm, medications and lifestyle may all affect your recovery time from any procedure. It is important to consult with your surgeon to decide which procedure is best for your condition.
While brain aneurysm surgery recovery time is an important consideration, it is incredibly variable and should not be the only factor when deciding whether or not to have surgery and, if so, which procedure is best for you. Both clipping and coiling are effective treatments for brain aneurysms, and an experienced neurosurgeon can help you determine which will likely have the best outcome for your particular situation.
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About Dr. Dorothea Altschul
Dr. Dorothea Altschul is an accomplished neurointerventionalist in North Jersey and is the Clinical Director of Endovascular Services at Neurosurgeons of New Jersey, practicing out of their Ridgewood office located on East Ridgewood Avenue.
