Surgical treatment of aneurysms

Explanation of surgical clipping, risks, recovery, and when it is preferred.

Surgical clipping is an established but more invasive method of treatment that still has a role in managing certain cerebral aneurysms. The procedure involves making an opening in the skull (a procedure called a craniotomy) to locate the aneurysm. With the help of a microscope, the surgeon places the clip on the aneurysm’s neck, sealing it off from the rest of the blood vessel.

Recovery times vary but are typically longer than for endovascular treatment. Like all surgical procedures clipping carries some risks. Strokes occur in about 5-15% of cases which can manifest as weakness in the limbs, disturbances in speech, or visual problems. There is about a 1% chance of catastrophic brain injury resulting in death. The surgery might also affect the area of your brain near the aneurysm. This could lead to short-term effects due to swelling or bruising, or in rare cases, long-term effects. These effects would be specific to the location of each aneurysm and may also cause neurological stroke-like symptoms.

The procedure can lead to some physical discomfort in the days following the surgery. Swelling and bruising to the face are common, which might cause your eyes to close temporarily. Alongside this headaches are relatively common. The wound site can become infected. One unusual sensation some patients note is the feeling that the bone flap, the piece of bone removed during the surgery, seeming to move. This sensation, while strange, is not dangerous. The bone flap is secured with plates during the operation and will heal properly in time. The muscle used for chewing food might be impacted temporarily by the operation. As this muscle heals, you might find it challenging to open your mouth or chew, but these symptoms typically resolve within six months.

The period following the operation requires careful management of your activities. In the first few weeks after going home, it’s essential to maintain a routine, stay hydrated, eat well, and rest regularly. Enlist help for household chores if possible and consider some gentle exercise to gradually build up your strength. Most people require about 2-3 months off work for full recovery. Returning to work earlier won’t necessarily harm you, but it may prolong the recovery period due to increased tiredness.

However, in skilled hands, surgical clipping can provide a solution for many types of aneurysms, particularly those that may not be suitable for other treatments, like coil embolisation or flow diversion.

References

1. Rizvi A, Seyedsaadat SM, Alzuabi M, Murad MH, Kadirvel R, Brinjikji W, Kallmes DF. Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2020 Jun;41(6):1043-1048. doi: 10.3174/ajnr.A6568. Epub 2020 May 28. PMID: 32467181; PMCID: PMC7342755.