Type of Surgery
Last updated: 11/24/2009
A major risk during surgery is a second rupture of the aneurysm during the procedure. Intraoperative rupture is very serious and associated with an approximately 30â€“35% morbidity and mortality of the patient. It is particularly dangerous if it occurs...
during the administration of the anesthesia or the opening of the dura mater because there will be a delay before the surgeon can control the bleeding.
Although much rarer than without surgical treatment, re-bleeding can occur even after surgery, particularly with improper placement of the clip. If too close to the parent vessel, the clip can block blood flow and promote brain damage in that area. If it is too far away from the parent vessel, a condition known as an aneurysmal rest can develop that will swell and rupture later. This rebleeding can also be described as a stroke, and occurs in between 1% and 10% of surgical patients.
Again rarer than without treatment, patients having their aneurysm clipped can also develop vasospasm after the procedure. The presence of vasospasm increases the occurrence of re-bleeding as well, making it a particularly dangerous complication. Treatments for vasospasm include giving medications that relax the smooth muscles in vessel walls, administering intravenous fluids to increase blood volume, or using drugs to increase blood pressure. In some cases, it may be necessary to open the vessel with a balloon catheter, a procedure called angioplasty. Angioplasty carries with it its own significant risks, including the formation of blood clots and rupture of the artery, and is effective only in some cases.
Other risks of the surgical treatment of cerebral aneurysms include neurological damage over and above what had occurred with the rupture. Special surgical procedures such as the use of temporary clips on the parent vessel, reduction of the patient's blood pressure, and administration of drugs that increase the brain tissue's ability to survive without oxygen are some techniques that minimize the amount of damage. Hypothermia (reduction of the patient's temperature during surgery) is sometimes also utilized to reduce the chance of this risk.
As this surgery involves opening of the cranium (skull), the procedure carries an increased risk of infection of brain and spinal tissues. This surgery also has all the risks of any other invasive procedure, such as infection at the incision site, and risks associated with anesthesia.
An artist's representation of what nerves and nerve bundles look like at the microscopic level. It also shows how the anatomy of a nerve allows it to transmit electrical signals and communicate with other neurons (nerves).
Cerebral aneurysm repair involves corrective treatment of an abnormal blood-filled sac formed by localized expansion of an artery or vein within the brain. These sacs tend to form at the juncture between a primary vessel and a branch. If the vessel involved is an artery, the lesion is also known as a berry aneurysm because of its round, berry-like appearance.
The purpose of the surgical treatment of cerebral aneurysms is to isolate the weakened vessel area from the blood supply. This is commonly done through the strategic placement of small, surgical clips to the neck of the lesion. Thus, the aneurysm becomes isolated from the normal circulation without damaging adjacent vessels or their branches and shrinks in size to become undetectable, a process known as aneurysm obliteration.
More than 60 percent of procedures neurosurgeons perform are spine-related, according to the National Neurosurgical Procedural Statistics 2006 Survey from the American Association of Neurological Surgeons (AANS).
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