Aneurysm surgery will differ for each patient based on the location and severity of the aneurysm. An aneurysm occurs when a blood vessel becomes weak or diseased and begins to stretch or balloon. This condition typically results from an inherited weakness when found in the abdominal aorta and thoracic aorta, but is thought to be acquired when it occurs in the brain. Because aneurysms are not commonly found in routine check-ups, patients are often diagnosed while searching for something else or after experiencing a rupture. Doctors usually recommend aneurysm surgery, but if the risks of surgery are too high, a patient may be monitored with blood pressure medicine instead.
The most common type of aneurysm occurs near the base of the brain in the circle of Willis. The circle of Willis is a circular formation of arteries that is vitally important in supplying blood to the brain. Symptoms of a rupture in a brain aneurysm include nausea, vomiting, severe headaches, dilation of a single pupil, neck stiffness, confusion, or seizures. If a doctor suspects the patient has an aneurysm, the patient may be subject to computed tomography scans, or CT scans, magnetic resonance angiography scans, or MRA scans, or a cerebral angiogram. Whether a patient is diagnosed with an aneurysm before or after its rupture, doctors will likely recommend aneurysm surgery because it is impossible to tell when an aneurysm will rupture.
Brain aneurysm surgery may be minimally invasive or open. The minimally invasive option, called coil embolization or endovascular coiling, addresses the aneurysm from within the blood vessel so that the patient does not have to be cut open. The doctor will insert a catheter, or small tube, into the blood vessel and direct it to the aneurysm using an X-ray technology called fluoroscopic imaging. Once the catheter reaches the aneurysm, the doctor will push small, platinum coils through the hollow inside of the catheter into the weakened area of the vessel. The coils fill the bulge, preventing blood flow to that area, and thus preventing a rupture.
A doctor may also recommend an open brain aneurysm surgery called neurosurgical clipping. In this procedure, a metal clip is clamped around the blood vessel just before the aneurysm. This restricts the flow of blood through the weakened portion of the vessel, preventing pressure from mounting in the aneurysm and causing a rupture. Both clipping and coiling have shown to be effective at excluding an aneurysm from the circulatory system and preventing the recurrence of bleeding. While endovascular coiling requires less recovery time, clipping may allow doctors to more effectively manage arterial spasms surrounding the aneurysm.
In the event of an aortic aneurysm, treatment recommendations will depend on the location and size of the aneurysm and the condition of the patient. The condition is diagnosed via ultrasound or CT scan and then the patient is administered pre-operative tests, such as an electrocardiogram (ECG), X-rays, and blood tests. If the patient can withstand aneurysm surgery and the bulge is severe enough to warrant it, the patient will be scheduled for surgery based on the urgency of the condition.
If the aneurysm is in the thoracic aorta, or the portion of the aorta that ascends from the heart in the chest, the patient will first be anesthetized and then cut in the chest. A patient with a large aneurysm in the abdominal aorta would be incised through the belly or the groin. Once the aneurysm is accessed, the surgeon will then remove the bulging portion of the blood vessel and replace it with a stent graft. A stent graft is a man-made tube that connects the severed ends of the blood vessel after the unhealthy portion has been removed.