Aneurysm Clipping

An aneurysm is a weak, bulging spot in a blood vessel, which can vary from one patient to another. Some may be discovered during a routine scan, while others come to attention only after causing symptoms or bleeding. These can grow and may rupture. Thus, causing severe bleeding, which makes evaluation essential.

Though not every aneurysm requires immediate attention, the ones that pose a risk of rupture should be treated to help reduce the risk of bleeding. Choosing the treatment method involves several factors, such as size, shape, location, and the patient's age and health.

One well-established surgical technique is aneurysm clipping. It is done to isolate the aneurysm from the normal blood circulation. However, before recommending this treatment option, healthcare providers assess the patient’s condition through imaging tests, neurological status, and associated risks.

At Gleneagles Hospitals, this decision is made after assessment by a multidisciplinary team of specialists. This ensures patients receive personalised care. 
 

An aneurysm can cause severe bleeding in the brain, and if it bursts, it may lead to strokes. Aneurysm clipping is a brain surgery that treats a brain aneurysm. The surgery involves using a metal clip that helps isolate the aneurysm from the rest of the circulation. This is done to prevent or treat a ruptured aneurysm. The procedure might be complex, but it prevents any potential damage to the brain.

After clipping, the aneurysm is excluded from circulation and often shrinks over time, although it does not necessarily disappear completely.
 

A ruptured aneurysm may cause a haemorrhagic stroke. This usually happens when bleeding puts pressure on your brain cells and causes brain damage. A neurologist may recommend clipping if - 

• The aneurysm has ruptured and needs immediate treatment to stop bleeding and prevent it from occurring again.
• It is growing or is large enough to increase rupture risk and carries the risk of bleeding.
• If it is causing symptoms, such as headaches, vision changes, or nervous compression.
• If the aneurysm is located in a surgically accessible location (closer to the brain’s surface).
   

Doctors check for suitability using clinical assessment. Doctors also order imaging studies, such as - 
 

• CT Angiography to check for a detailed vascular anatomy
• Magnetic Resonance Angiography (MRA)
• Digital Subtraction Angiography (DSA)
• Neurological examination
• Cardiopulmonary assessment
• Lab tests, such as blood type, coagulation profile, and kidney function, among many others

During assessment, the healthcare provider weighs the risks based on the patient's overall condition, age, and comorbidities. 

Aneurysm clipping may not be suitable for every patient. Hence, it may not be considered in the case of - 
 

• If the aneurysm is smaller than 3 mm.
• In elderly patients (>70 years) or those who have major comorbidities.

Posterior circulation aneurysms may sometimes be better suited to endovascular treatment rather than clipping.
 

Aneurysm clipping provides an effective and durable treatment option for appropriately selected patients. If the aneurysm is ruptured, the procedure can cause the bleeding to stop and also prevent any bleeding in the future.

However, it should be noted that any brain damage caused by an aneurysm prior to treatment may leave a long-lasting disability. Some studies have also reported that the procedure has a success rate exceeding 95%. It is always best to consult and discuss everything, including the success potential, with your concerned surgeon or doctor.
 

Before the surgery, doctors advise the patients on fasting instructions, depending on the time of the operation. It is also advised to stop smoking before the surgery.

Once the patient reaches the hospital:

• They are taken to the neurological ward and changed into a hospital gown.
• Doctors will explain the procedure, and the patients may be asked to sign a consent form.
• The patient is then taken to the surgical theatre, where they are given anaesthesia through an IV.
• Doctors and a team of healthcare providers monitor the patient throughout the procedure.
• Also, the hair of the patient might be shaved over the planned surgical site for better access.
   

The aneurysm clipping surgery usually takes 3-5 hours. The procedure mainly focuses on controlling blood flow and preventing damage to the brain.

During the surgery - 

• Using a specialised tool, the surgeon will make an incision in the scalp and locate a part of the skull.
• They make small holes and connect them to remove the “bone flap.”
• Next, the surgeon opens the protective covering of the brain called the dura.
• The surgeon will expose the brain and find the aneurysm.
• A metallic clip is placed along the neck of the aneurysm.
• The bone flap is then put back together and secured with metal plates and screws.
• The wound is then stitched and covered with bandages. 
   

After the surgery, it is utmost important to get plenty of rest. According to the NHS, recovery can take between 6 and 8 weeks.

The patient should stay in the hospital for 2-5 days. When the patient is discharged, a family member should be present to drive them home. 
 

• After the surgery, patients can expect fatigue and occasional headaches, and this is common while they are recovering.
• If the surgery is done after a subarachnoid haemorrhage, it is expected to feel tired for up to 6 months.
• Some may even experience pain in the temporal region while chewing.

Note: It is advised to continue taking painkillers as per doctor’s instructions, drink plenty of water, and rest when feeling tired. These aid in proper recovery. 
 

Although most people recover well, permanent brain damage can occur after the procedure and may result in - 

• Seizures
• Problems with sensation
• Problems with movement
• Some patients may experience changes in memory, concentration, or other cognitive functions

It is important to see a doctor if the patient experiences - 

• Vomiting
• Loss of consciousness or sudden deterioration
• Severe headache
   

Aneurysm clipping is most commonly used because it has a low re-rupture rate. Thus, becoming a gold standard for certain aneurysm types. 

• Clipping is usually chosen for aneurysms that are large or located near the brain surface.
• Over time, clipping has shown lower recurrence in certain anatomical and size categories.
• With more refined techniques, it is considered a long-standing procedure that minimises the risk of infection, bleeding, or stroke.
• The metal clip used remains in place permanently, and causes the aneurysm toshrink. 
   

Gleneagles Hospitals in India offer access to a - 

• Team of multidisciplinary neurological doctors
• Advanced diagnostic imaging (such as DSA and MRI)
• Highly functional operating rooms with monitoring tools, such as EEG (to detect early signs of cerebral ischemia) and MEP (to monitor motor function and detect possible motor deficits).
• The care continuum extends beyond the operating room. Gleneagles offers dedicated nursing, physical rehabilitation, and intensive care monitoring, among other services.
• A comprehensive treatment plan based on the individual’s health, aneurysm severity, and aneurysm size.

Patients can contact us via the website or call to book an appointment. 
 

The timely evaluation and treatment of a brain aneurysm can make a huge difference. While surgery for an aneurysm (aneurysm clipping) is not necessary for everyone, it is a trusted and effective treatment for aneurysms that are at higher risk of rupturing or already causing bleeding.

Following the healthcare team’s advice before and after surgery, attending follow-up appointments, and reporting any concerning symptoms immediately all assist in a smoother recovery. As every patient has a unique condition, an expert team of doctors at Gleneagles Hospitals works together to evaluate each patient.