Open Surgery for Aneurysms

Brain aneurysms stem from weaknesses in the blood vessel walls of the brain, carrying the risk of rupture and consequential disability or fatality. Treatment options include open surgery aimed at eliminating these vulnerable points in the blood vessels, thereby drastically lowering the risk of rupture.

This article will delve into the intricacies of brain aneurysm surgery, encompassing what patients can anticipate throughout the procedure, potential outcomes, and the subsequent recovery process.

A brain aneurysm is a sac-like protrusion that stems from a weak segment on a blood vessel in the brain. Aneurysms can rupture, leading to a potentially fatal brain bleed called a subarachnoid hemorrhage. When discovered intact, your doctor may recommend treatment to prevent the aneurysm from rupturing in the future. A ruptured aneurysm is a medical emergency that will involve treatment to control the bleeding and prevent further complications.

Treatment of aneurysms may be performed via an endovascular or open approach. Endovascular techniques involve insertion of a thin, flexible tube (catheter) through an artery in the groin or arm. It is then navigated to the target artery in the brain, where special devices are deployed to stop the flow of blood to the aneurysm. While this is a minimally invasive approach, it may not be the best option for all patients, particularly for more complex and irregularly shaped aneurysms.

In other cases, open brain surgery, where the skull is opened via craniotomy, may be the preferred approach. The decision to treat endovascularly or with open brain surgery depends on individual patient factors such as age and overall health. In addition, treatment decision-making depends on characteristics of the aneurysm itself, including its location, size, and shape.

Although surgery is more invasive and often has a longer recovery period, it may be necessary, based on aneurysm characteristics. One of the most common indications for open aneurysm surgery is size. Although there is no distinct size cutoff, larger aneurysms more often require open surgical treatment.

Open aneurysm surgery is usually done through the placement of a metal clip around the neck of the aneurysm. As a result, blood flow to the aneurysm is cut off and the weak point in the vessel is eliminated.

If the aneurysm is irregularly shaped and a clip cannot be easily placed, a bypass technique may be used.  Bypass techniques involve rerouting the blood vessels around the aneurysm, which reduces blood flow to the aneurysm.

Undergoing brain aneurysm surgery is a serious step, and it requires the expertise of highly trained neurosurgeons, many of whom have additional training in treating vascular conditions. The surgery itself can take between 4 to 6 hours, or sometimes longer, depending on the complexity of your aneurysm.

One of the main risks during surgery is bleeding from the aneurysm, which can happen while it’s being treated. If significant bleeding occurs, it can reduce blood flow to the brain and may lead to a stroke. While these risks are rare, they are serious and can potentially lead to disability or, in rare cases, be life-threatening.

There are other risks associated with the surgery, such as infection or damage to nearby nerves and brain tissue. After surgery, it’s also common for patients to feel more tired or confused, but these symptoms are often temporary and tend to improve with time.

The good news is that survival rates for brain aneurysm surgery are generally positive, particularly for aneurysms that have not ruptured. In emergency situations, where surgery is needed for a ruptured aneurysm, the outlook can be more challenging, not because of the surgery itself, but due to the blood loss and potential brain damage that can happen before reaching the operating room.

Your medical team will take every precaution to ensure the best possible outcome, and support you every step of the way.

The length of a hospital stay after brain aneurysm surgery can vary depending on the individual patient. For patients with unruptured aneurysms, the stay may last several days, with doctors closely monitoring vital signs and neurological health before it’s safe to go home.

However, for patients treated for a ruptured aneurysm, the hospital stay may last several weeks or more. When a rupture occurs, blood enters the space around the brain, referred to as a subarachnoid hemorrhage, potentially causing blood vessels to narrow (vasospasm), which can lead to a stroke if not treated. Since the risk of vasospasm is highest in the weeks following the rupture, staying in the hospital for close monitoring during this time is crucial.

The goal of aneurysm surgery is to prevent recurrence or rupture. Most cases of surgical clipping are successful, but approximately 1-3% of aneurysms experience complications, including an additional hemorrhage event, that may require returning to the operating room for repair. The duration and complexity of long-term recovery after brain aneurysm surgery varies depending on individual factors, particularly whether the aneurysm had previously ruptured.

For patients with ruptured aneurysms, recovery is often prolonged and more challenging due to brain damage from the initial hemorrhage. Conversely, recovery for unruptured aneurysms typically spans 4 to 8 weeks.

Initially, patients may experience fatigue, headaches, and difficulty concentrating, alongside swelling and discomfort around the surgical incision. These symptoms generally diminish over time. It is crucial to engage with your healthcare team to establish a safe and holistic recovery plan.

Modern surgical aneurysm clips are known for their strength and durability, usually composed of high-quality materials, such as titanium. These clips are usually safe for MR imaging and are unlikely to trigger metal detectors in public places, like the airport. 

• Brain aneurysms are sac-like protrusions stemming from weak points in blood vessels of the brain that can rupture causing severe disability and even death.
• Aneurysms may be treated with endovascular or open brain surgery. Treatment decisions depend on a variety of patient factors and aneurysm characteristics.
• Open brain aneurysm surgery dramatically reduces the risk of rupture from brain aneurysms.
• Brain aneurysm surgery is not without side effects and risks. Many side effects go away with time, and most patients do well after they recover from surgery.

• National Institute of Neurological Disorders and Stroke
• American Association of Neurological Surgeons (AANS): Cerebrovascular Disease
• Brain Aneurysm Foundation
• American Association of Neurological Surgeons (AANS): Cerebral Aneurysm
• American Brain Foundation (ABF)