Aneurysm Chapter 9
Cerebral Aneurysm Surgery
If the cerebral aneurysm is small-less than 1/2 inch (1 cm)-then the doctor may advise only monitoring to detect growth or onset of symptoms. Cerebral surgery is risky. It can pose some of the same dangers that a ruptured aneurysm can, if the aneurysm ruptures during surgery and bleeding cannot be controlled: stroke, disability, and death.
There are two surgical options available: microvascular clipping and occlusion. In microvascular clipping, a section of the skull is removed and the aneurysm is located. A small, metal, clothespin-like clip is applied to the aneurysm's neck so that the flow of blood to the aneurysm is cut off. The clip remains in the brain and prevents future bleeding; in general, aneurysms that are surgically clipped don't return. The piece of skull is put back in place and the scalp is closed.
Occlusion is similar to microvascular clipping, but in this case the entire artery is clamped off (occluded). This is often done when the artery has been damaged by the aneurysm. Sometimes occlusion is accompanied by a bypass, where a small blood vessel is surgically grafted to the brain artery, rerouting the blood flow away from the section of damaged artery.
As with aortic aneurysms, there is a nonsurgical alternative. It's called endovascular embolization. In this procedure the doctor inserts a catheter into an artery, usually in the groin, and threads it through the body up into the site of the aneurysm. Using a guide wire, small balloons or coils of soft platinum wire are passed through the catheter and released into the aneurysm. The balloons or coils fill the aneurysm, blocking its blood flow and so effectively destroying it. Endovascular embolization is considered less risky than cerebral surgery, but there are still the risks of bleeding, infection, and damage to artery.
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