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What is it?
A cerebral aneurysm is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood. How they form is not entirely clear, but as many as one in 20 people may have an aneurysm. Most cerebral aneurysms do not show symptoms until they either become very large or burst. Small, unchanging aneurysms generally will not produce symptoms, whereas a larger aneurysm that is steadily growing may press on tissues and nerves. Symptoms may include pain above and behind the eye; numbness, weakness, or paralysis on one side of the face; dilated pupils; and vision changes. When an aneurysm bleeds, an individual may experience a sudden and extremely severe headache, double vision, nausea, vomiting, stiff neck, or loss of consciousness. Patients usually describe the headache as “the worst headache of my life” and it is generally different in severity and intensity from other headaches patients may experience. People experiencing this “worst headache,” especially when it is combined with any other symptoms, should seek immediate medical attention.
What is its goal?
The primary goal of aneurysm clipping is to stop blood from flowing into the aneurysm. The biggest risk of an aneurysm is that it may rupture. This is a medical emergency, as a ruptured aneurysm can lead to significant neurologic injury or even death. By preventing blood from flowing into an aneurysm, it cannot rupture.
For very large aneurysms causing neurologic symptoms, a secondary goal of surgery is to decrease the aneurysm’s size in order reverse a patient’s symptoms.
How is it done?
In the operating room with the patient asleep, a section of the skull is removed. Using a microscope, the neurosurgeon works around the brain to find the aneurysm, which is typically underneath the brain. Once the aneurysm is found, the surgeon will place a small, metal, clothespin-like clip across the base of the aneurysm, preventing blood from entering it. The clip remains in place, preventing it from rupturing. The piece of skull is then replaced and the scalp closed.
What are the risks?
As with any disease of the brain, the decision to undergo treatment for cerebral aneurysm requires a careful consideration of possible benefits versus risks. Risks of aneurysm clipping include bleeding, infection, and stroke-like symptoms. There is no easy formula that can allow physicians and their patients to reach a decision on the best course of therapy—all therapeutic decisions must be made on a case-by-case basis.
What is the success rate?
For the vast majority of patients who undergo aneurysm clipping, surgery permanently fixes the aneurysm. In certain situations, your surgeon may recommend additional imaging studies (such as CT or MRI scanning) to make sure the aneurysm has not reformed after surgery.
How long will I stay in the hospital?
How long a patient stays in the hospital largely depends on how the patient came to medical attention. If the aneurysm was discovered and operated on before it ruptured, then the patient may expect to be hospitalized from three to five days. However, if the aneurysm ruptured, then the patient can expect to remain hospitalized for at least two weeks. This additional time is to watch for certain serious side-effects that may result from having blood spilled around the brain at the time of rupture.
What is special about the way we deliver this treatment?
The University of Rochester Department of Neurosurgery includes surgeons specially trained to provide full care for all diseases involving the blood vessels of the brain. They are members of a multidisciplinary team that also includes Stroke Neurologists and Neuroradiologists. The team meets regularly to discuss all aspects of patients with complex problems.