An aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. It can leak blood and cause a stroke or bleeding along the surface of the brain (also called a subarachnoid hemorrhage).

See also: Aneurysm in the brain

Your doctor will decide the best way to perform surgery on your aneurysm. Endovascular repair, most often using a "coil" or coiling, is a less invasive way to treat some aneurysms.

During endovascular repair of an aneurysm, your surgeon blocks off the aneurysm before it can break open (ruptures).

• It is usually done in the radiology section of the hospital. You will have general anesthesia and a breathing tube.
• A catheter is guided through a small cut in your groin to an artery and then to the small blood vessels in your brain where the aneurysm is. Thin metal wires are put into the aneurysm. They then coil up into a mesh ball. Blood clots that form around this coil prevent the aneurysm from breaking open and bleeding.
• During and right after this procedure, you may be given a blood thinner called heparin.

If an aneurysm in the brain ruptures, it is an emergency and needs medical treatment, and often surgery. Endovascular repair is more often used when this happens.

A person may have an aneurysm but not any symptoms. This kind of aneurysm may have been noticed when an MRI of your brain was done for another reason.

• Your doctor will help you decide whether it is safer to have surgery on the aneurysm or not.
• Clipping is the more common way to repair an aneurysm. This is done during an open craniotomy. See also: Brain surgery (craniotomy)

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems

Possible risks of brain surgery are:

• Surgery on any one area may cause problems with speech, memory, muscle weakness, balance, vision, coordination, and other functions. These problems may be mild or severe, and they may last a short while or they may not go away.
• Blood clot or bleeding in the brain
• Seizures
• Stroke
• Infection in the brain
• Brain swelling

Signs of neurological problems include:

• Vision problems (from blindness to peripheral vision problems)
• Speech problems
• Confusion
• Problems noticing things around you
• Behavior changes
• Loss of balance or coordination

This procedure is often performed on an emergency basis. If it is not an emergency:

• Tell your doctor or nurse what drugs or herbs you are taking and if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always try to stop smoking.
• You will usually be asked not to eat or drink anything for 8 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive.

A hospital stay for endovascular repair of an aneurysm may be as short as 1 to 2 days if there was no bleeding beforehand.

The hospital stay after craniotomy and aneurysm clipping is usually around 4 to 6 days. When bleeding or other complications occur before or during surgery, the hospital stay can be 1 to 2 weeks, or more.

You will probably have an x-ray test of the blood vessels in the brain (angiogram) before you are sent home.

After successful surgical treatment for an aneurysm, it is uncommon for it to bleed again. Growth of the aneurysm may be less likely after craniotomy and clipping when compared to intravascular repair, and both are more likely to prevent enlargement and bursting when compared to doing nothing.

The outlook also depends on any brain damage that occurred from bleeding before, during, or after the surgery.

Bashir Q, Badruddin A, Aletich V. Endovascular techniques for stroke prevention. Neurol Clinic. 2008 Nov;26(4): 1099-127.

Patterson JT, Hanbali F, Franklin RL, Nauta HJW. Neurosurgey. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 72.