Overview
Microsurgery is a treatment for brain aneurysms that is performed under a high magnification operating microscope and neuro-endoscope, a tubular instrument with a built-in video camera.
Microsurgical treatment consists of a craniotomy, which involves the removal of the skull base bone to expose the aneurysm. Once the aneurysm is exposed, nonmagnetic titanium clips are used to treat the aneurysm.
Another microsurgical approach is to perform brain artery bypass to exclude the aneurysm from circulation.
Microsurgery involves a team of neuro-anesthesiologists and neurophysiologists who monitor the brain during the procedure. Brain monitoring is conducted using Doppler and angiographic scans that ensure the adequacy of aneurysm clipping and to confirm that adjacent branch arteries remain open and unblocked.
Procedural Details
The initial treatment of the aneurysm by endovascular coiling [link to treatment article] or clipping is only a part of the management needed to optimize recovery for patients with subarachnoid hemorrhage.
The patient’s problems often include brain injury from the initial hemorrhage, vasospasm of the brain arteries, hydrocephalus, hyponatremia (low sodium concentration in the blood) and other medical complications. The patients are monitored and treated for several days in the intensive care unit by a team of nurses, physicians and other health care professionals.
In addition to monitoring cardiac, cerebrovascular and neurological parameters, patients are also evaluated by transcranial Doppler and single photon emission computed tomography (SPECT) scanning for the occurrence of vasospasm, the sudden constriction of a blood vessel that causes a reduction in blood flow.
When present and clinically relevant, patients are treated medically with hypertensive, hypervolemic, hemodilutional (HHH) therapy and frequently by endovascular angioplasty.
Effectiveness
Patients with subarachnoid hemorrhage caused by aneurysms often require neurological and psychological rehabilitation to enable them to become independent and return to their former activities.
The aneurysm management team assists the patients in achieving their maximum recovery potential. Sometimes, the recognition of persisting hydrocephalus and treatment by a ventriculo-peritoneal shunt may improve the patient’s functional recovery dramatically. In other instances, adjusting the patient’s medications or finding the right rehabilitation facilities may make a great difference in recovery.