An aneurysm occurs when an area on an artery wall becomes weak, creating a sac that balloons out and fills with blood. Aneurysms can remain stable throughout life, but in some cases they enlarge, or rupture – a life-threatening medical emergency. To reduce the risk of rupture, your doctors may recommend a surgical procedure that blocks the flow of blood into the aneurysm. Depending on factors such as your age, overall health, and the size, configuration and location of your aneurysm, treatment options include clipping, coiling or pipeline embolization.
Aneurysm Clipping
Clipping is an open-surgery procedure that places a metal clip directly across the stem, or neck, of an aneurysm at the place where it joins the parent artery. Because this procedure requires a craniotomy to open the skull, it may not be appropriate for everyone, particularly older patients and people with serious health problems.
Preparing for Aneurysm Clipping
Before clipping unruptured aneurysm surgery, you can expect to have a series of tests to check for any underlying health conditions and to establish the location of your aneurysm. During this time, it’s important to talk to your doctor about any medications you may be taking and allergies you may have. Because clipping surgery requires general anesthesia, you will be restricted from eating or drinking in the six to eight hours before the procedure.
The Clipping Procedure
In aneurysm-clipping surgery, a portion of the skull is removed and the outer covering of the brain is opened to access the aneurysm and place the clip. Once the clip is in place, the skull is reattached and the incision is closed. Because the clip blocks the flow of blood into the aneurysm, it shrinks and disappears over time. Aneurysm clipping surgery typically takes a few hours.
Recovering From Clipping Surgery
Without complications, clipping surgery usually requires a hospital stay of three to five days. At home, your recovery typically takes between three and six weeks. You can expect restrictions on activities such as driving, lifting and taking baths, but you can gradually resume normal activities during that period.
Aneurysm Coiling
Clipping surgery is not right for everyone. Depending on your individual circumstances, your neurosurgeons may recommend coiling, a relatively new and less invasive procedure that blocks blood flow into an aneurysm by filling it with coils of flexible platinum wire.
Preparing for Aneurysm Coiling
Preparing for your coiling procedure begins with blood tests and a complete examination with imaging to establish the size and location of the aneurysm. Coiling takes place in a hospital under general anesthesia, so you can expect to have restrictions on eating and drinking for six to eight hours before the procedure.
The Coiling Procedure
Coiling is performed by directing a catheter to the aneurysm through an incision in the femoral artery in the groin. At the aneurysm site, neurosurgeons insert the coils to fill the aneurysm. In some cases, a stent might be inserted as well to keep the coils in place. When the coils are in place, the catheter is withdrawn and the incision is closed. Coiling typically takes between one and three hours.
Recovering From a Coiling Procedure
After a coiling procedure, you can expect to spend a day or two in the hospital. Right after the procedure, you will need to lie flat for up to six hours with your leg extended. Without complications, your recovery at home can take about a week, with a gradual return to normal activities during that time.
You can expect to see your doctors for follow-ups to check the healing of your incision and the placement of the coils. In most cases, coiling resolves an aneurysm completely, but in some situations, the coils can become compacted, so that blood can start to fill the aneurysm again. In those cases, a second coiling might be needed to close off the aneurysm.
The Pipeline Procedure
Like coiling, the pipeline procedure is a minimally invasive endovascular procedure. The pipeline procedure can also treat certain kinds of wide-necked aneurysms that were previously considered too difficult to treat surgically.
Preparing for a Pipeline Procedure
Preparing for a pipeline procedure is similar to preparations for aneurysm coiling. You will have imaging and blood tests, and your doctors will be prescribed blood-thinning medications to take before and after surgery. If you take other medications, you may be asked to stop taking them or change your dose before surgery.
The Pipeline Procedure
In a pipeline procedure, neurosurgeons target not the aneurysm itself, but the parent artery. A wire mesh sheath called a pipeline embolization device, or PED, is directed to the aneurysm site through a catheter in the femoral artery in the groin. The sheath is placed in the artery at the site so that the opening of the aneurysm is blocked and blood can flow normally through the artery.
Recovering From a Pipeline Procedure
Like coiling, a pipeline procedure requires a day or so in the hospital. Right after the procedure, you must lie flat with your leg extended for a few hours. At home, your recovery typically takes a week or two, and you can expect to have follow -ups to check your incision and the placement of the PED.
Unruptured brain aneurysms can be treated by clipping, coiling or a pipeline procedure – and your neurosurgeons will work with you to determine which treatment option is right for your unique circumstances.
