Microsurgical aneurysm clipping
This is a surgery performed to treat aneurysms of the brain. As the aneurysm grows in size, its wall can become so thin that even minor changes in blood pressure can cause it to rupture, releasing blood into the space around the brain (subarachnoid hemorrhage). The volume of the hemorrhage determines the severity of the patient’s condition.
Purpose of the operation
The goal is to isolate, “disconnect” the aneurysm from normal blood circulation, without blocking the nearby small perforating arteries.
Operation
Under general anesthesia, the neurosurgeon performs a craniotomy (a small opening in the skull with the removal of a flap). Under a microscope, the vessels are carefully separated from the brain with the release of the aneurysm sac. Then, a titanium clip (a tiny spring clip) is placed on the neck of the aneurysm. Its blades tightly clamp the neck of the aneurysm, isolating it from normal vessels. After the clip is applied, the aneurysm is dissected, and if necessary, its walls are partially removed. The clip remains on the aneurysm permanently.
Cerebral aneurysms vary in shape and size. Saccular aneurysms have a narrow neck, body, and fundus. These are the most amenable aneurysms to surgery, with the neck being relatively easy to clip.
Some aneurysms have a wide, irregular neck, a spindle-shaped structure, which requires the use of several clips of different shapes, curvatures and lengths of blades, or the imposition of vascular anastomoses.
Factors for surgery
The choice of the type of operation (clipping or endovascular embolization ) is made individually in each case and depends on many factors:
- the severity of the patient’s condition,
- type of aneurysm,
- presence of hemorrhage,
- concomitant diseases,
- severity of brain edema according to MSCT data.
