Definition
Definition
Microvascular clipping is a surgery to cut off blood flow to an aneurysm. This prevents bleeding and rupture. Typically, a portion of the skull is removed (a procedure called a craniotomy) and restored during this complex, open surgery.
Reasons for Procedure
Reasons for Procedure
Microvascular clipping treats a brain aneurysm. It will not fix already damaged areas of the brain, but it can improve quality of life by stopping bleeding or preventing rupture.
Brain AneurysmAn aneurysm is a weakened blood vessel in the brain that collects blood. The bulging, blood-filled pocket can put pressure on parts of the brain, pressing on nearby nerves. This can cause symptoms or cause the blood vessel to rupture (hemorrhage).
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Possible Complications
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Weakness
- Numbness or tingling
- Speech disturbances
- Visual changes
- Confusion, memory loss
- Seizures
- Infection
- Reaction to anesthesia
- Kidney damage
- Blood clots
- Ruptured aneurysm during surgery
Factors that may increase the risk of complications include:
Discuss these risks with your doctor before surgery.
What to Expect
What to Expect
Prior to Procedure (Non-emergency Surgery)
Your appointment before the surgery may include:
- Physical exam and blood tests
- Imaging tests—ultrasound, CT scan, MRI scan, or angiogram
- Discussion of allergies
- Discussion of medications you are taking, including over-the-counter and herbal supplements
- Discussion of recent illness or other conditions
- Discussion of risks and benefits of treatment options
Women should let their doctor know if they are pregnant or planning to become pregnant.
Before your procedure:
- Arrange for a ride home.
- No food or drink after midnight the night before the procedure.
- Discuss your medications with your doctor. You may be asked to stop taking certain medications before your procedure.
Anesthesia
General anesthesia will be used. It will block any pain and keep you asleep through the surgery.
Description of the Procedure
In the operating room, the nurses and doctors will connect you to monitors to watch your blood pressure, heart rate, and pulse. A catheter will be inserted to collect urine during surgery. An IV will be placed in your arm for sedation and anesthesia. The nurse will cut the hair off an area of your head for surgery.
The doctor will perform a craniotomy, removing a small section of the skull to access the brain. X-rays and microscopic viewing may help the doctor find the exact weakened area of the blood vessel. The aneurysm will be separated from nearby healthy brain tissue. The doctor will then place a titanium clip to clamp off the entire artery to the aneurysm to isolate it from general circulation. The clip will stay in place to permanently prevent bleeding and/or rupture.
The section of skull will be replaced, and the scalp will be stitched back into place.
Immediately After Procedure
When the procedure is done, the catheter and IV line will be removed. You will need to lie still for 6-8 hours or more. You will stay in the ICU for about a day. Your blood pressure and other vitals will be monitored closely. You may be given medication for pain or other symptoms.
How Long Will It Take?
3-5 hours or more
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
The surgery is done in a hospital setting. The usual length of stay is 4-6 days. Your doctor may choose to keep you longer if complications arise.
Post-procedure Care
At the Hospital
- You will rest for several hours.
- Nurses will monitor your vital signs.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered.
There are also steps you can take to reduce your chance of infection, such as:
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
At Home
When you get home, you may have to adjust your activity level while you recover. This may take 3-6 weeks. Home care may include:
- Resting when you need to
- Caring for the wound
- Physical or rehabilitative therapy
Call Your Doctor
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Any changes in physical ability, such as balance, strength, or movement
- Any changes to mental status, such as consciousness, memory, or thinking
- Weakness, numbness, tingling
- Signs of infection including fever and chills
- Redness, swelling, increasing pain, bleeding, or discharge from the incision site
- Headache
- Changes in vision
- Fainting
- Pain that cannot be controlled with the medications you’ve been given
- Persistent nausea or vomiting
- Trouble controlling your bladder and/or bowels
- Pain, swelling, or cramping in your legs
Call for emergency medical services right away if any of the following occurs:
- Seizure
- Shortness of breath or chest pain
- Loss of consciousness
If you think you have an emergency, call for medical help right away.
RESOURCES:
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov
CANADIAN RESOURCES:
Heart and Stroke Foundation Canada http://www.heartandstroke.ca
References:
http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Cerebral%20Aneurysm.aspx
Updated August 2009. Accessed May 29, 2014.
NINDS cerebral aneurysm information page. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/cerebral_aneurysm/cerebral_aneurysms.htm
Updated April 16, 2014. Accessed May 29, 2014.
Subarachnoid hemorrhage.EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated May 2, 2014. Accessed May 29, 2014.
Treatment of brain aneurysms. The Aneurysm and AVM Foundation website. Available at:
http://www.taafonline.org/ba_treatment.html#ba_clipping
Accessed May 29, 2014.
Williams LN, Brown RD Jr. Management of unruptured aneurysms. Neurol Clin Pract. 2013;3(2):99-108.
Last Updated: 5/29/2014