A cerebral aneurysm is an abnormal sac-like dilatation of a cerebral artery with a weakened wall, that may break in the event of a blood pressure increase. The rupture of a cerebral aneurysm usually causes the so-called subarachnoid haemorrhage.
This effusion is a bleed in the space between the brain and the membranes covering it. Sometimes it can be accompanied by a bruise inside the brain.
Subarachnoid haemorrhage due to aneurysm has a high mortality with about 30% of patients dying, a third of them before reaching the hospital. About half of those who survive may be affected by some kind of sequel.
When is the intervention indicated?
The objective of the surgery is to prevent the aneurysm from breaking and producing a cerebral or subarachnoid haemorrhage, also preventing it from growing, compressing or producing a lack of blood supply due to theft or embolism.
If it has already broken, the surgery is intended to prevent it from breaking again and to prevent a repeated haemorrhage (rebleeding). It also allows to avoid, and to treat more adequately, other complications that may occur after bleeding (vasospasm, hydrocephalus) or improve symptoms secondary to compression or irritation of nerve structures. If there is an associated intracranial hematoma, it can be evacuated in the same intervention.
What does the operation consist of?
The operation of an intracranial cerebral aneurysm consists of a craniotomy, or window through the skull. Then the brain is incised and the subarachnoid space necessary to reach the aneurysm is dissected. A metal clip (a sort of pincer) is placed on the neck of the aneurysm to close it.
It is a complex and important risk operation depending on the location and shape of the aneurysm, there being a risk to the patient's life especially if the aneurysm ruptures during the intervention.
What are the risks, complications and possible sequelae?
This intervention is extremely complex and delicate. Anaesthesia and care in the ICU are also very complex. There may be postoperative complications related to the surgery (haemorrhage, infection, leakage of the fluid covering the brain through the wound (called cerebrospinal fluid fistula), related to the manipulation of the arteries (cerebral infarction), of the brain (cerebral contusion, cerebral inflammation epileptic seizures) or cranial nerves (facial paralysis, paralysis of other cranial nerves). Any of these complications can lead to a transient or permanent neurological worsening of the patient's symptoms or to the appearance of other new symptoms (one-side body paralysis, speech or understanding inability, visual disturbances, superior functions disorders, coma, etc).
There are also complications not directly related to surgery (pulmonary infection, venous thrombosis, embolism, lack of sodium in the blood, anaemia, gastrointestinal bleeding, etc). Finally, it is possible that some problems are the consequence of the haemorrhage produced by the aneurysm rupture and not by the surgery. Even if the final outcome and complications depend on the patient's condition, for any other reason, postoperative mortality may reach 10% in some cases.
Postoperative of cerebral aneurysm surgery
The usual postoperative period will depend greatly on the situation of the patient before the operation. After leaving the operating room, the patient will go to the Resuscitation / Intensive Care Unit (ICU) where he will remain at least until the day after the operation.
This aims to make recovery from anaesthesia slow and ideal for a brain that has been recently operated. It also allows a better monitoring of the patient in the first hours, and the possibility to detect early complications that may require a new intervention. Once back to the Neurosurgery unit, the patient will be progressively getting up until he finally leaves bed 24 to 48 hours after the intervention. The postoperative operation of a head operation of this sort is often not particularly painful. Pain produced in the wound is usually controlled correctly with conventional painkillers. The patient will be discharged from hospital 4-7 days after surgery depending on their previous condition and postoperative recovery, provided there are no complications. After 7-8 days of the surgery the stitches are removed.
What happens to the hospital discharge?
You must strictly follow medical treatment indicated by your neurosurgeon at the time of discharge.
During the first month after the operation the patient must lead a very quiet life, without making any efforts or physical exercise. As much as possible is, the advice is that you are in company of a person throughout the day. You can read or watch television for a while without becoming fatigued, since the effort of concentration in a single activity could lead to a headache. It is recommended to gradually increase the rhythm of activity during the first month. In the third week, if your clinical condition allows it, you may go out and walk for 15 minutes without getting tired. After 4 weeks the patient is expected to go back to the Neurosurgery Outpatients ward for the evolutionary control of the operation.