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Microvascular Clipping

Definition

Microvascular clipping is a surgery to cut off blood flow to an aneurysm . This prevents bleeding and rupture. Typically, a portion of the skull is removed (a procedure called a craniotomy ) and restored during this complex, open surgery.

Reasons for Procedure

Microvascular clipping treats a brain aneurysm . It will not fix already damaged areas of the brain, but it can improve quality of life by stopping bleeding or preventing rupture.
Brain Aneurysm
IMAGE
An aneurysm is a weakened blood vessel in the brain that collects blood. The bulging, blood-filled pocket can put pressure on parts of the brain, pressing on nearby nerves. This can cause symptoms or cause the blood vessel to rupture (hemorrhage).
Copyright © Nucleus Medical Media, Inc.

Possible Complications

If you having this procedure, your doctor will review a list of possible complications, which may include:
  • Weakness
  • Numbness or tingling
  • Speech disturbances
  • Visual changes
  • Confusion, memory loss
  • Seizures
  • Infection
  • Reaction to anesthesia (eg, light-headedness, low blood pressure, wheezing)
  • Kidney damage
  • Blood clots (eg, stroke )
  • Ruptured aneurysm during surgery
Factors that may increase the risk of complications include:
Discuss these risks with your doctor before surgery.

What to Expect

Prior to Procedure (Non-emergency Surgery)

Your appointment before the surgery may include:
  • Physical exam, blood and imaging tests
  • Discussion of allergies
  • Discussion of medicines you are taking, including over-the-counter and herbal supplements
  • Discussion of recent illness or other conditions
  • Discussion of risks and benefits of treatment options
Women should let their doctor know if they are pregnant or planning to become pregnant.
You will meet the neurosurgeon performing the procedure.
Also:
  • Imaging tests (ultrasound, CT , MRI , angiogram) may be done before the procedure. Bring paperwork and scans to the hospital as directed.
  • Arrange for a ride home.
  • Fasting—No food or drink after midnight the night before the procedure.
  • Discuss your medicines with your doctor. You may be asked to stop taking certain medicines before your procedure. Common medicines to stop include aspirin , nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV (needle) in your hand or arm.

Description of the Procedure

In the operating room, the nurses and doctors will connect you to monitors to watch your blood pressure, heart rate, and pulse. A catheter will be inserted to collect urine during surgery. An IV will be placed in your arm for sedation and anesthesia. The nurse will cut the hair off an area of your head for surgery.
The doctor will perform a craniotomy, removing a small section of the skull to access the brain. X-rays and microscopic viewing may help the doctor find the exact weakened area of the blood vessel. The aneurysm will be separated from nearby healthy brain tissue. The doctor will then place a small titanium clip at the neck of the aneurysm, stopping blood from flowing. The clip will stay in place to permanently prevent bleeding and/or rupture.
The section of skull will be replaced, and the scalp will be stitched back into place.

Immediately After Procedure

When the procedure is done, the catheter and IV line will be removed. You will need to lie still for 6-8 hours or more. You will stay in the ICU for about a day. Your blood pressure and other vitals will be monitored closely. You may be given medicine.

How Long Will It Take?

3-5 hours or more

How Much Will It Hurt?

You may feel a pinch when your IV is inserted for anesthesia. Anesthesia prevents pain during surgery. Pain or soreness after the procedure can be managed with pain medicine.

Average Hospital Stay

The surgery is done in a hospital setting. The usual length of stay is 4-6 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital
  • You will rest for several hours.
  • Nurses will monitor your vital signs.
At Home
It will take at least 3-6 weeks to recover. When you return home, do the following to help ensure a smooth recovery:
  • Rest often.
  • Keep blood pressure under control.
  • Cleanse the incision site as directed. Use a soft wash cloth to gently wipe the incision area and keep dry.
  • Take medicine as directed.
  • Engage in rehabilitative therapy as directed.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow all of your doctor’s instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Any changes in physical ability—balance, strength, or movement
  • Any changes to mental status—level of consciousness, memory, thinking, or responsiveness
  • Weakness, numbness, tingling
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
  • Headache that does not go away
  • Changes in vision
  • Fainting
  • Pain that you cannot control with the medicines you have been given
  • Nausea and/or vomiting that you cannot control with the medicines you were given, or that continue for more than two days after leaving the hospital
  • Trouble controlling your bladder and/or bowels
Call for medical help or go to the emergency room right away if any of the following occurs: 
  • Seizure
  • Shortness of breath, or chest pain
  • Loss of consciousness
If you think you have an emergency, call for medical help right away.

RESOURCES

The Brain Aneurysm Foundation http://www.bafound.org/

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

CANADIAN RESOURCES

Brain Injury Association of Alberta (BIAA) http://www.biaa.ca/

Heart and Stroke Foundation Canada http://ww2.heartandstroke.ca/splash

References

American Association of Neurological Surgeons. Treatment options for cerebral aneurysms. American Association of Neurological Surgeons website. Available at: http://www.neurosurgerytoday.org/what/patient%5Fe/treatment.asp . Accessed June 3, 2010.

The Aneurysm and AVM Foundation. Brain aneurysms. The Aneurysm and AVM Foundation website. Available at: http://www.taafonline.org/ba%5Ftreatment.html#ba%5Fclipping . Accessed June 3, 2010.

Mayo Clinic. Brain aneurysm. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/brain-aneurysm/ds00582 . Accessed June 3, 2010.

National Institute of Neurological Disorders and Stroke. Cerebral aneurysm fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/cerebral%5Faneurysm/detail%5Fcerebral%5Faneurysm.htm . Accessed June 3, 2010.

Neff D. Brain aneurysm. EBSCO Patient Education Reference Center. Available at:  http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Published May 1, 2010. Accessed June 2, 2010.

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