Aneurysms: By The Numbers
Unruptured brain aneurysms are relatively common in the general population, found in ~3.2% of the adult population (average age of 50) worldwide. With the continued widespread use of high resolution magnetic resonance imaging (MRI) scanning, they are being discovered with an increasing frequency.
The large majority of those will never rupture. For example, of the one million adults in the general population (aged 50), around 32,000 harbor an unruptured brain aneurysm, but only 0.25% of these (or 1 in 400) will rupture. To put these numbers in perspective, in any given year, around 80 of 32,000 of these unruptured brain aneurysms would be expected to present with a brain bleeding (subarachnoid hemorrhage).
In many cases, aneurysms are small and go unnoticed throughout a person’s life. But if an aneurysm enlarges, or ruptures, surgery may be needed to seal the aneurysm with a permanent metal clip. If you’re a candidate for surgery, knowing what to expect before and after your procedure can help your aneurysm clipping recovery go smoothly.
What Causes a Brain Aneurysm?
Aneurysms in the brain, also called cerebral aneurysms, can have many causes, and can remain undiagnosed for a lifetime as long as no symptoms arise.
Some aneurysms are present at birth, caused by abnormalities and weak areas in places where blood vessels join. Others arise from inherited connective tissue disorders and conditions such as Marfan’s syndrome or polycystic kidney disease.
Chronic and Acute Health Conditions
People with atherosclerosis, or “hardening of the arteries,” are more susceptible to aneurysms, and so are those with high blood pressure. Although rare, infections of the artery wall can weaken its structure so that an aneurysm can develop.
Events and Lifestyle Choices
Certain kinds of aneurysms can be caused by a head injury or other trauma. Smoking and abusing alcohol or drugs, especially cocaine, is associated with aneurysms.
Who Needs Surgery?
Many small aneurysms never cause symptoms at all. This kind of aneurysm might be found during examinations or testing for other conditions. But if an aneurysm enlarges, filling with more blood, it begins to put pressure on the surrounding tissues of the brain, causing symptoms such as a severe headache, vision disturbances, and problems with coordination, speech or memory, typically in conjunction with headaches. If you experience these symptoms, or if other testing reveals a brain aneurysm, clipping surgery may be needed to prevent a rupture.
When an aneurysm ruptures, blood leaks into the tissues of the brain and the spinal fluid, which can cause severe damage to the brain or even death. A ruptured aneurysm is an emergency that requires immediate treatment.
Preparing for Your Aneurysm Clipping Procedure
If you have an unruptured aneurysm that requires clipping surgery, preparation for the procedure begins several days or weeks before the surgery itself, so you’ll be able to make any needed preparations for your hospital stay and recovery at home.
Before your surgery, you can expect to have a series of tests to assess your overall health condition and pinpoint the exact location of your aneurysm. Your medical team will meet with you to sign necessary consent forms and go over your pre-surgery instructions.
During this time, it’s important to talk with your doctors about any medications you may be taking for other conditions, as well as any supplements or alternative remedies you use, since they may affect the medication you’ll be given for surgery. You may be asked to stop taking certain medications or to change your usual dose prior to your surgery, or your doctor may prescribe new, pre-surgery medications. If you smoke or use alcohol, your doctors may ask you to stop.
Without complications, you can expect to stay in the hospital for two to three days, so it’s important to make all the necessary arrangements, such as taking caring of your dependents, missing work or school, and meeting any other obligations during your hospital stay. Pack a bag with any essentials you’ll need during your hospital stay, and update any care directives you may have. While you’re preparing for surgery, make plans for your return home, too.
Since driving and other activities will be restricted for the first few weeks, be sure to arrange for transportation and help with daily chores. Plan with supervisors or teachers to manage your absence from work or school.
Learn About Potential Risks
Clipping surgery is a well-researched and established treatment for many kinds of brain aneurysms. This procedure is generally safe and can resolve an aneurysm completely. But it is an invasive surgery that does have some significant risks, including blood clots, brain swelling and the potential for neurological problems, such as confusion, or stroke-like impairment of speech or coordination.
Clipping surgery also carries the risk of seizures or vasospasm, a narrowing of a blood vessel in the brain that can occur days or weeks after surgery. A major risk of clipping surgery, especially when performed on a ruptured aneurysm, is re-bleeding from the aneurysm site. After clipping surgery, patients may also experience headaches and swelling in the face and around the incision site. As with any surgery, infection is also a risk.
Clipping Surgery: What to Expect
Brain aneurysm clipping surgery begins with a craniotomy — an opening in the skull. The size and location of the incision depend on the location of the aneurysm. In some cases, only a small incision is needed to place the clip. In other cases, the surgeon must remove a portion of the skull over the aneurysm. Your hair will be parted along the incision line without cutting or shaving it. Once the neurosurgeon has removed a small piece of bone, the brain folds will be spread to get access to the aneurysm. The neurosurgeon then places a metal clip across the “neck” of the aneurysm, where it meets the artery, to close it off. Once completely clipped, the aneurysm eventually shrinks and scars down.
The clip placed across the aneurysm will remain in place permanently and should not cause problems. The surgeon then closes the incision. Depending on circumstances, this might include replacing a portion of the skull and securing it with metal plates and screws for secure healing. You will be able to walk through airport securities without setting off any alarms.
Managing Your Aneurysm Clipping Recovery
Aneurysm clipping recovery depends on many factors. If no other complications are present, your post-surgery hospital stay will likely be two to three days. On average, recovery typically takes between four and six weeks, with a gradual return to normal activities during that time. You should plan to be out of work for four to six weeks. Factors such as age and general health can affect recovery time, though. Older patients and those with chronic conditions such as cardiovascular disease and diabetes may take longer to recover.
Your health care providers will make sure you receive specific instructions on how to make sure your aneurysm clipping recovery goes smoothly. You may have restrictions on driving, bending over and other activities for a period after surgery, so plan ahead for ways to accommodate those limitations, such as arranging for someone to drive you to appointments and for errands.
You may have pain at the surgery site and other symptoms such as fatigue, headache or swelling around your eyes and face, so your doctor may prescribe medications to reduce pain and speed healing. It’s important to take all medications as directed and to follow recommendations about resuming your usual medications, since some, such as blood thinners, can affect your recovery.
It’s also vital to get as much rest as you can. Feeling tired is a common post-surgery complaint, and sleep can help your body recover. It’s also important to get moderate, low-impact exercise such as walking as soon as your doctor approves. This can improve circulation and blood flow and prevent problems such as pneumonia. You should be able to resume a normal diet, but medications may cause stomach upsets.
Some post-surgery symptoms, such as a severe headache with nausea, aren’t normal. Learn what symptoms to watch out for, and keep emergency numbers handy in case those problems arise.
Although a clipped aneurysm usually doesn’t require further treatment, your health care team might recommend lifestyle changes such as exercising more, quitting smoking or controlling high blood pressure, since these factors can be associated with the development of atherosclerosis (hardening of the arteries,) which can contribute to the development of aneurysms. You may also have to be monitored for other aneurysms that could develop over your lifetime.
Know Your Clip
Aneurysm clips are made from several different materials, including titanium and stainless steel, and it can be important to know what kind of clip you received during surgery. Some are compatible with MRI scanning, while others can be displaced by magnetic forces during the scan — an event that could cause serious injury or death. Most clips placed in the year of 2000 or thereafter are MRI-safe. If you expect to undergo an MRI at any time after having aneurysm clipping surgery, check with your surgeon to be sure that the clip used in your procedure is MRI-safe.
Clipping surgery is a highly successful and safe treatment for brain aneurysms. Though everyone’s situation is unique, clipping surgery can make it possible to return to normal life, with the aneurysm resolved.