Aneurysm Clipping Surgery and Craniotomy
Since Walter Dandy first developed and performed the procedure in 1937 surgical Clipping of an Aneurysm has been considered the gold standard of treatment. Even though it is a major and very invasive surgery and despite modern alternatives, it retains this position. Though, in essence, still the same surgery that Dandy developed so long ago modern techniques, equipment, and medications along with the general advancements in medicine have improved the procedure immeasurable.
The goal of Aneurysm clipping surgery is to place a small coil spring metal clip-modern clips are made of titanium, which is safe for use during MRI-across the neck of the Aneurysm, isolating it from the parent vessel and preventing bleeding or re-bleeding. Though it can vary dependent on several variants such as the Aneurysm location, equipment available, and the surgeon’s preferences, the procedure is generally as follows and can take 3-5 hours contingent on the complexity of the individual case.
The patient is given a general anesthesia and, once asleep, their head is placed in a three-pin skull fixation device, or jig, that will hold the head in the proper position for the surgeon to perform the operation. The area for the incision is prepared, the scalp is shaved, (sometimes the entire head and sometimes just the area of incision) cleaned and disinfected. Medications to relax the brain are sometimes administered at this point.
The procedure to open the skull and provide the surgeon access to repair the Aneurysm is called a Craniotomy, the removal of a portion of bone. There are several different variations of this operation and several variables factor into the decision on which to use. To perform the Craniotomy an incision is made. The muscles and other tissue are moved away from the skull exposing the bone. Small holes, called burr holes are drilled into the skull, which allows access for a jigsaw like bone saw to cut away a section of the skull. The portion of bone, or bone flap, is lifted out and the dura mater, the brain’s protective covering is exposed.
The dura mater is also opened and folded back to expose the brain. Surgical instruments called Retractors are carefully placed on the brain to gently move it and, with the aid of an operating microscope, the surgeon will open a passage that will provide access between the brain and skull for the surgeon to locate and repair the Aneurysm.
Once access to the arteries at the base of the brain has been gained the surgeon will locate the Aneurysm and prepare it for the clip. The Aneurysm is delicate and manipulation, particularly of the dome, can cause it to burst. Often the surgeon will attempt to control the blood flow and, should the Aneurysm burst during surgery, a temporary clip can be placed across the parent vessel to stem the flow of blood. It is also often necessary to separate the Aneurysm from surrounding tissue and structures, with which it may have bonded.
The Aneurysm clip is placed in an applicator, which will hold it open, and the surgeon will place it on the neck of the lesion, ensuring that no other arteries or tissues are trapped by the clip. The clip is then released and it closes on the neck of the Aneurysm thus isolating it from its parent artery.
Once the surgeon is satisfied with the placement of the clip, that it has isolated and stopped the flow of blood into the Aneurysm while not impeding the flow of blood in the parent artery the retractors are removed. The dura mater is then closed, the bone flap replaced and secured to the skull with titanium plates or wire mesh and screws. The incision is closed and sutured and a turban like dressing applied.
Nothing on this website should, in any way be considered medical advice. It is presented as general information only and is not intended to diagnose or treat any type of medical condition. I am not a doctor, nurse, or any other type of medical or health care professional. Nor am I an expert on Aneurysms. However, I am an expert on the experience of having suffered a ruptured Aneurysm and the subsequent treatment I received. This site should not be considered to be, nor is it intended to be, a definitive source of information regarding Aneurysms. I have made every attempt to ensure the accuracy of any information presented here, but again, I am not a medical professional and my own interpretation of this information could be in error.