Related Information Surgery poses the lowest risk when it is performed before an aneurysm ruptures. The patient’s condition, the size and location of the aneurysm, and other factors determine the risk of surgery. This surgery is done under general anesthesia. The surgical method for treating an unruptured aneurysm. The surgeon exposes the aneurysm with a craniotomy and places a metal clip across the base of the aneurysm so that blood cannot enter it. Clipping is an open surgical procedure to seal off the aneurysm neck and, thus, prevent blood from entering the aneurysm, which obliterates it. Clipping of brain aneurysms has been available longer than endovascular therapy, and has excellent long-term results. The neurosurgeon makes an incision behind the hairline or on the back of the head, depending on the location of the aneurysm. From there a section of bone, or bone plate, is removed (craniotomy) from the skull to expose the brain tissue. The neurosurgeon approaches the aneurysm in the opening between the skull and the brain, but does not go through brain tissue. Under a microscope, the aneurysm is carefully separated from the normal blood vessels and the brain, so the neurosurgeon can see it and properly treat it.
The aneurysm is then clipped with a device that resembles a tiny clothespin. With the clip in place, the aneurysm is totally sealed off, and no more blood can enter it. The bone plate is then secured into place and the wound is closed. Aneurysms that are quite large or involve a large section of the blood vessel may require special procedures, such as putting clips on either side of the aneurysm or making a bypass( A surgical operation in which the surgeon creates a new channel to bring blood flow to the brain. In rare cases when an aneurysm can’t be clipped or coiled, the surgeon may have to perform a bypass operation, bringing blood flow through a new channel beyond the aneurysm and then trapping the segment of the artery with the aneurysm between clips.) around the aneurysm.
Once the aneurysm is clipped the Blood Pressure is raised to the pre-op level. This should be done slowly over about 10 mins. The maintenance of adequate filling pressures and Blood Pressure will help prevent vasospasm becoming clinically significant.
Approach - Pterional approach
Indications - Unruptured aneurysm - Size (Too small or Too large) - Inability to navigate delivery system to aneurysm site - Anatomy (parent artery, branch artery, perforator incorporation into neck)