Aneurysm Surgery:

Weak blood vessels in the brain can bulge out like a balloon, causing a condition called aneurysm. When an aneurysm ruptures, it spills out the blood it carries, into the brain, causing a life threatening condition. Hence, an aneurysm requires immediate treatment in the following cases:

If the aneurysm grows in size.
If the patient exhibits symptoms like sudden, severe headache.
Aneurysm rupture.

There are two types of aneurysms:

Saccular and Fusiform:

Saccular aneurysms constitute about 80-90% of all brain aneurysms. They are tiny, rounded and shaped like a berry or a sac. These aneurysms are usually located at the bifurcation of blood vessels and in the base of the brain and are very prone to rupture.
A Fusiform aneurysm is less common. It just looks like a bulged out blood vessel. This kind of aneurysms rarely ruptures.

HOW IS AN ANEURYSM IDENTIFIED:

A small un-ruptured aneurysm rarely exhibits any symptoms. However, if the aneurysm is a large one, it causes symptoms by compressing upon the nearby blood vessels and nerves of the brain. Further evaluation is required if the patient experiences the following symptoms.

Headache
Blurred eyesight
Pain behind and above the eyes
Weakness of the body
Numbness of the body
Difficulty speaking

In case of an aneurysm rupture, the patient experiences the following symptoms:

Sudden, severe, headache (described by the patient as the worst headache of his/her life)
Loss of consciousness
Blurred eyesight
Nausea
Vomiting
Stiff neck
Sudden change in mental status
Sudden seizures
Sudden weakness
Sudden numbness

Immediate medical attention is to be sought, if 2 or more or the above symptoms, associated with sudden, severe headache are experienced.

TREATMENT OF AN ANEURYSM:

Rupture of an aneurysm is one of the most threatening medical conditions. Treatment depends on the patient’s age, location and size of the aneurysm. There is no medical or conservative treatment for aneurysm. Surgery is the only options. However, with advances in medicine, improved surgical techniques are now available in the successful treatment of an aneurysm.

Unlike the past, not all aneurysms require an open surgery in which the skull had to be opened, to fix the aneurysm, Now a days, clipping and coiling of aneurysms can be done by just inserting a thin long tube inside the brain. With help of real time video guidance, the aneurysm can be clipped or coiled. The procedure has high success rate and little or no complication.

Nevertheless an already ruptured aneurysm comes in as a surgical emergency and in majority of the cases would require an open Brain surgery, so as to successfully evacuate the blood from the brain and simultaneously fix the ruptured blood vessel.

GOALS OF TREATMENT:

Prevent bursting of an aneurysm.
Prevent re-bleeding of an already ruptured aneurysm.

FIXING THE ANEURYSM:

Described below is a brief description of the surgical techniques used in the correction of an aneurysm:

Open Surgical “Clipping”: This is an open procedure. The procedure is performed through a small opening made on the skull or over the eyebrows. Through the opening, affected blood vessel is identified and clipped. Placing the clip on the bulging blood vessel prevents blood from entering the aneurysm. In this way the bulge collapses and the aneurysm heals. Patient is discharged after a day or two of observation in the hospital.
Endovascular Coiling: Under the guidance of a real time X ray imaging technique, a thin long catheter is inserted into the brain, through a blood vessel in the hip that travels all the way to the brain. Once the bulging blood vessel is reached, coils are introduced and packed into the aneurysm up to a point that the vessel is blocked. This prevents blood flow from entering the aneurysm. The catheter is then safely removed. Sometimes, a stent or balloon may be needed to keep these coils in place. Patients may be discharged immediately the next day, following the procedure.

RECOVERY:

If an open surgery is performed, it may take at least 4 weeks to recover completely and return to normal activities. However, after an endovascular coiling procedure, patient is observed for 24 hours and he/ she can be discharged immediately the next day. Normal activities can be resumed anytime thereafter.