Last Updated on November 26, 2025 by Bilal Hasdemir

Patients with a brain aneurysm need top-notch care that focuses on safety and recovery. Fixing a bulging blood vessel wall is a delicate task. It requires a team of skilled experts.

The main aim of a brain aneurysm operation is to stop the aneurysm from bursting. This is why surgery is so important in treating this condition.

Key Takeaways

• Advanced, compassionate care is key for brain aneurysm patients.
• Surgery is vital to prevent rupture and improve outcomes.
• Liv Hospital’s team excels in surgical procedures.
• Quick surgery or endovascular treatment is needed for ruptured aneurysms.
• The main goal is to stop bleeding and aid in recovery.

Understanding Brain Aneurysms

It’s important to know about brain aneurysms to understand the risks and how to prevent them. A brain aneurysm is a bulge in a blood vessel in the brain. It can rupture, causing serious health problems.

What Is a Brain Aneurysm?

A brain aneurysm happens when a blood vessel in the brain weakens. This causes it to bulge or balloon out. If it ruptures, it can lead to bleeding in the brain, known as a subarachnoid hemorrhage.

Types of Brain Aneurysms:

• Saccular aneurysms: These are the most common type and are often referred to as berry aneurysms.
• Fusiform aneurysms: These aneurysms are characterized by a uniform dilation of the blood vessel.
• Dissecting aneurysms: These occur when there is a tear in the inner layer of the blood vessel wall.

Risk Factors and Causes

Several factors can increase the risk of developing a brain aneurysm. These include:

Risk Factor	Description
Genetics	Family history of aneurysms can increase an individual’s risk.
Smoking	Smoking is a significant risk factor as it damages blood vessel walls.
High Blood Pressure	Hypertension can weaken blood vessels, making them more susceptible to aneurysm formation.

“The presence of certain genetic conditions, such as polycystic kidney disease, can significantly increase the risk of developing brain aneurysms.” –

Johns Hopkins Medicine

Signs and Symptoms of Rupture

An unruptured aneurysm may not cause symptoms unless it leaks or ruptures. When a rupture occurs, symptoms can include:

1. Severe headache, often described as “the worst headache of my life”
2. Double vision or other visual disturbances
3. Nausea and vomiting
4. Seizures

Recognizing these symptoms is critical for prompt medical intervention. According to Johns Hopkins Medicine, an unruptured aneurysm may not cause symptoms unless it leaks or ruptures. This can lead to severe headache, double vision, or eye pain.

Diagnosis and Assessment Methods

Diagnosing brain aneurysms requires a detailed approach. It uses various imaging methods to spot and check these serious conditions.

Advanced Imaging Techniques

Advanced imaging is key in finding brain aneurysms. Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI), and cerebral angiography help see the aneurysm.

The right imaging method depends on the aneurysm’s location and size, and the patient’s health. CT scans are quick and good for emergencies. MRI gives detailed views of soft brain tissues, helping spot small aneurysms.

Aneurysm Classification Systems

Brain aneurysms are sorted by size, location, and shape. Knowing these types helps pick the best treatment. The size of an aneurysm is key, as bigger ones are more likely to burst.

• Small aneurysms (<7mm) are often watched closely.
• Medium aneurysms (7-12mm) might get surgery or coiling.
• Large aneurysms (13-24mm) and giant ones (>24mm) need more complex treatments.

Rupture Risk Assessment

Figuring out the risk of an aneurysm bursting is very important. Size, location, and patient details like age and smoking are looked at. The PHASES score helps guess the risk of bursting, guiding treatment choices.

Using advanced imaging, aneurysm types, and risk checks helps doctors fully understand each patient. This leads to better treatment plans and outcomes.

Types of Brain Aneurysm Procedures

Brain aneurysm treatment varies for each patient. The right brain aneurysm procedure depends on the aneurysm’s location, size, and the patient’s health.

At Johns Hopkins Medicine, surgical clipping and endovascular coiling are main treatments. Flow diversion is also an option. Each method is chosen based on the aneurysm and patient factors.

Surgical Clipping Approach

Surgical clipping requires a craniotomy to reach the aneurysm. A clip is then placed to block the aneurysm from blood flow. It’s effective for some aneurysms, mainly those that are easy to get to.

Endovascular Coiling Technique

Endovascular coiling is a less invasive method. Coils are inserted through a catheter to clot the aneurysm. It’s good for hard-to-reach aneurysms or those not suited for surgery.

Flow Diversion Devices

Flow diversion uses a device to change blood flow, causing the aneurysm to clot. It’s for complex aneurysms that can’t be treated by clipping or coiling.

Procedure	Description	Indications
Surgical Clipping	Involves clipping the aneurysm neck	Accessible aneurysms, certain sizes and locations
Endovascular Coiling	Coils deployed to promote clotting	Difficult to access aneurysms, patient-specific factors
Flow Diversion	Devices alter blood flow to promote thrombosis	Complex aneurysms not suitable for clipping or coiling

Emerging Interventional Methods

New brain aneurysm procedures are being developed. These aim to improve results, shorten recovery times, and offer more options for complex cases.

Choosing a procedure is very personal, showing how complex brain aneurysm treatment is. A team of experts is key in picking the best treatment for each patient.

Patient Selection for Different Surgical Approaches

Choosing the right patients for brain aneurysm surgery is complex. It requires careful thought. The decision to operate depends on many factors to find the best surgical approach.

Factors Influencing Treatment Decisions

Several factors affect the choice of surgery for brain aneurysms. These include the aneurysm’s size and location, the patient’s health, and any comorbidities. 

Key factors include:

• Aneurysm size and location
• Patient’s age and overall health
• Presence of symptoms or rupture
• Comorbid conditions

Unruptured vs. Ruptured Aneurysm Management

Managing unruptured and ruptured aneurysms is different. Unruptured aneurysms are often watched or treated on purpose. Ruptured aneurysms need urgent care. The choice between clipping and coiling depends on the aneurysm and the patient’s health.

Characteristics	Unruptured Aneurysm	Ruptured Aneurysm
Treatment Urgency	Elective	Emergency
Primary Treatment Options	Monitoring, Surgical Clipping, Endovascular Coiling	Surgical Clipping, Endovascular Coiling
Considerations	Aneurysm size, location, patient health	Immediate risk reduction, vasospasm prevention

Contraindications for Specific Procedures

Some conditions make certain surgeries not suitable. For example, severe comorbidities might rule out open surgery. Complex aneurysm shapes might not work for endovascular coiling.

Deciding on brain aneurysm treatment is complex. It needs a deep look at each patient’s situation. Understanding these factors helps doctors make better choices for their patients.

Pre-Surgical Preparation Protocol

The pre-surgical phase is key in treating brain aneurysms. It includes steps to get the patient ready for surgery. This makes the surgery more likely to succeed.

Comprehensive Patient Evaluation

A detailed patient evaluation is the first step. It looks at the patient’s medical history and current health. Advanced imaging techniques like MRI and CT angiography are used to understand the aneurysm’s size and location.

The patient’s overall health is also checked. This includes any other health issues that might affect the surgery or recovery. This approach helps the surgical team plan the best strategy for each patient.

Anesthesia Considerations and Planning

Anesthesia planning is another important part. The anesthesiologist works with the surgical team to create a plan. They choose the right anesthetic agents and techniques for the patient’s comfort and safety.

Careful monitoring of the patient’s vital signs and brain function is done during the surgery. This helps spot and fix any problems quickly.

Surgical Team Preparation

The surgical team’s preparation is also critical. This includes neurosurgeons and the whole perioperative team. Rehearsal of the surgical plan and review of imaging studies are done to ensure everyone knows the details.

Good communication among team members is key. It helps the surgery go smoothly and according to plan.

Step-by-Step: Surgical Clipping Procedure

To treat brain aneurysms, neurosurgeons use the surgical clipping procedure. This method has been improved over many years. It involves several important steps, each needing great skill and precision.

Craniotomy Technique and Approach

The first step is a craniotomy. This is when a part of the skull is temporarily removed to get to the brain. The way the craniotomy is done is key to avoid hurting the brain and to see the aneurysm well.

Key Considerations for Craniotomy:

• Preoperative planning using advanced imaging techniques
• Choosing the best craniotomy site based on the aneurysm’s location
• Removing bone carefully to avoid damage to structures below

Microsurgical Dissection and Aneurysm Exposure

After the craniotomy, microsurgical dissection is done to find the aneurysm. This careful process involves moving through brain tissue to get to the aneurysm. Special tools and techniques are used.

The goal of microsurgical dissection is to see the aneurysm and the blood vessels around it clearly.

Clip Selection and Placement Strategy

Choosing and placing the clip are very important steps. The clip must match the size and shape of the aneurysm’s neck perfectly.

Clip Type	Aneurysm Size	Neck Characteristics
Straight Clip	Small	Narrow Neck
Curved Clip	Medium	Wide Neck
Fenestrated Clip	Large	Complex Neck Anatomy

Intraoperative Assessment and Closure

After the clip is placed, the surgeon checks to make sure the aneurysm is closed off. They might use imaging like intraoperative angiography to check for any problems.

Key Steps for Intraoperative Assessment:

1. Checking if the aneurysm is closed off
2. Looking at the blood vessels around it
3. Closing the craniotomy site

The surgical clipping procedure is very complex. It needs a lot of skill and knowledge. By knowing the steps, neurosurgeons can help patients with brain aneurysms get better.

Step-by-Step: Endovascular Coiling Procedure

Endovascular coiling is a modern way to fix aneurysms in the brain. It’s less invasive than traditional surgery. A catheter is guided through blood vessels to the aneurysm. There, coils are placed to stop bleeding and promote clotting.

Vascular Access and Catheter Navigation

The first step is getting vascular access. This is done through the femoral artery in the groin. A small cut is made to insert a catheter. Advanced imaging techniques help guide the catheter to the brain.

Once at the aneurysm, a microcatheter is used. Real-time imaging helps place it correctly in the aneurysm sac.

Digital Subtraction Angiography Mapping

Digital Subtraction Angiography (DSA) is key in this procedure. It gives clear images of the blood vessels and the aneurysm. This helps map and assess the aneurysm’s size, shape, and location.

Coil Selection and Deployment Technique

Coil selection depends on the aneurysm’s size and shape. The coils help stop bleeding by promoting clotting. They are released through a microcatheter into the aneurysm sac.

• Coils are made of various materials, including platinum and other biocompatible metals.
• The number and size of coils used depend on the aneurysm’s characteristics.
• Coil deployment is monitored in real-time using DSA to ensure accurate placement.

Aneurysm Size	Coil Type	Number of Coils
Small (<5mm)	Soft Coils	1-2
Medium (5-10mm)	Standard Coils	2-4
Large (>10mm)	Complex Coils	4 or more

Angiographic Assessment and Completion

After deploying the coils, DSA is used to check if the aneurysm is closed. This step is vital to confirm the procedure’s success and spot any issues.

The procedure is finished when the aneurysm is closed and there are no complications. The catheter is then removed, and the access site is closed.

Emergency Brain Aneurysm Procedures for Ruptured Cases

Emergency brain aneurysm procedures are key for managing ruptured cases. They help improve patient outcomes. A ruptured aneurysm causes a subarachnoid hemorrhage, a life-threatening condition needing quick medical help.

Initial Stabilization Protocols

The first step in managing a ruptured brain aneurysm is to stabilize the patient. This prevents further brain damage. The steps include:

• Maintaining airway patency and ensuring adequate oxygenation
• Controlling blood pressure to prevent re-rupture
• Administering anticonvulsants to prevent seizures
• Implementing measures to reduce intracranial pressure (ICP)

Managing Increased Intracranial Pressure

Increased ICP is a common issue after an aneurysm ruptures. To manage it, doctors use:

1. Administering osmotic diuretics like mannitol
2. Implementing hyperventilation to reduce PaCO2 levels
3. Ensuring proper drainage of cerebrospinal fluid through ventriculostomy

Urgent Surgical Decision-Making

Deciding on surgery depends on several factors. These include the patient’s condition, aneurysm location, and complications like hydrocephalus or hematoma. A team makes this decision, weighing the risks and benefits of immediate surgery versus waiting.

Vasospasm Prevention and Treatment

Cerebral vasospasm is a major complication after an aneurysm rupture. It can cause delayed brain ischemia. To prevent and treat it, doctors use:

• Administering nimodipine to prevent vasospasm
• Maintaining euvolemia and avoiding hypovolemia
• Using intra-arterial vasodilators or angioplasty for severe vasospasm

Managing ruptured brain aneurysms requires a detailed approach. This includes initial stabilization, managing complications, and timely surgery. Understanding these emergency procedures helps healthcare providers improve outcomes for these critically ill patients.

The Brain Aneurysm Procedure: Multidisciplinary Team Approach

Treating brain aneurysms needs a team effort from many medical experts. A multidisciplinary team makes sure all patient care needs are met. This includes diagnosis, treatment, and recovery.

Neurosurgical Team Composition

The neurosurgical team leads in treating brain aneurysms. They have skilled neurosurgeons who do surgeries and other treatments. For more on brain aneurysm surgery, check out Brigham and Women’s Hospital.

Role	Description
Neurosurgeons	Perform surgical clipping and other operative techniques.
Nurses and Surgical Technicians	Assist during surgery and provide patient care.

Role of Interventional Neuroradiologists

Interventional neuroradiologists are key in treating brain aneurysms with endovascular methods. They use advanced imaging to guide procedures like coiling and flow diversion.

Endovascular techniques have changed how brain aneurysms are treated. They offer patients less invasive options than traditional surgery.

Neuroanesthesia Considerations

Neuroanesthesia focuses on anesthesia for neurological surgery patients. Neuroanesthesiologists work with the neurosurgical team. They ensure patient safety and comfort during surgery.

• Monitoring patient’s vital signs during surgery.
• Managing anesthesia to prevent brain injury.
• Ensuring rapid recovery post-surgery.

Intraoperative Neurophysiological Monitoring

Intraoperative neurophysiological monitoring (IONM) is vital during brain aneurysm surgery. It uses techniques to watch the nervous system in real-time. This helps avoid neurological damage.

The success of treating brain aneurysms depends on teamwork. A multidisciplinary team combines neurosurgeons, interventional neuroradiologists, neuroanesthesiologists, and more. This team approach gives patients the best care, leading to better outcomes.

Conclusion: Outcomes and Advances in Brain Aneurysm Treatment

Brain aneurysm treatment has seen big improvements, leading to better results for patients. New imaging and surgical tools have made fixing cerebral aneurysms more successful. This has lowered the chance of rupture and improved recovery chances.

Doctors now treat brain aneurysms in a more tailored way. Thanks to endovascular coiling and surgical clipping, patients face fewer complications and heal faster.

As technology keeps getting better, brain aneurysm treatment will likely get even more effective. New treatments and methods will help more people, giving hope to those dealing with this condition.

FAQ

References

1. Molyneux, A., Kerr, R., Stratton, I., Sandercock, P., Clarke, M., Shrimpton, M., & International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. (2002). International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised trial. The Lancet, 360(9342), 1267–1274. https://www.sciencedirect.com/science/article/pii/S0140673602113146