Reasons
Cerebral aneurysms are one of the main causes of intracranial hemorrhage. If the aneurysm ruptures again, the risk of life-threatening complications increases significantly, so early surgery (within the first 72 hours after the hemorrhage) is recommended.
One of the most common operations performed in the world for the treatment of cerebral aneurysms is endovascular embolization with microcoils. As with clipping , the goal of the operation is to exclude it from the general circulation, which is necessary to prevent re-rupture.
Special instruments are used to perform endovascular surgery:
- microcatheters,
- conductors,
- platinum microspirals
- and their means of delivery.
Operation
This minimally invasive endovascular operation does not require craniotomy. The operation is performed through the femoral artery – a single puncture of the skin in the groin area. Catheters are sequentially inserted along the vascular bed into the neck vessels, cerebral arteries and directly into the aneurysm cavity.
Using a microcatheter, platinum microcoils are inserted into the aneurysm, filling its cavity and blocking the flow of blood into it from the general vascular bed. A low-voltage electric current is used to separate the microcoils from the supporting conductor.
Subsequently, blood flow in the aneurysm stops, the aneurysm completely thromboses and no longer poses a threat of rupture.
Balloons and stents
In the case of a complex aneurysm configuration (wide neck, spindle-shaped shape, etc.), a special technique using balloons and stents is used.
Endovascular surgery is performed under constant X-ray control on a special device – a digital angiograph. An iodine-containing contrast agent is used to visualize the vessels.
The endovascular embolization method is minimally invasive and can be used in patients with an increased risk of general anesthesia, in patients in serious condition, in elderly patients, and in cases inaccessible to clipping.
Factors to consider
The final decision on the choice of surgical method is made individually, taking into account many factors:
- the anatomical structure of the aneurysm,
- severity of the condition,
- presence of hemorrhage.
If the patient was receiving aspirin, clopidogrel, warfarin, it is necessary to stop taking them a few days before the operation. The postoperative period after embolization is easier, there is no need for dressings. In the absence of hemorrhage, discharge from the hospital usually occurs on the 2nd-3rd day.
