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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).
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Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Weakness
  • Numbness or tingling
  • Speech disturbances
  • Visual changes
  • Confusion, memory loss
  • Seizures
  • Infection
  • Reaction to anesthesia
  • Kidney damage
  • Blood clots
  • 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 medications 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.
Before your procedure:
  • Imaging tests (ultrasound, CT scan , MRI scan , or angiogram) may be done. 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 medications with your doctor. You may be asked to stop taking certain medications before your procedure.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

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 titanium clip to clamp off the entire artery to the aneurysm to isolate it from general circulation. 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 medication for pain or other symptoms.

How Long Will It Take?

3-5 hours or more

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

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.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered.
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
When you get home, you may have to adjust your activity level while you recover. This may take 3-6 weeks. Home care may include:
  • Resting when you need to
  • Caring for the wound
  • Physical or rehabilitative therapy

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • Any changes in physical ability, such as balance, strength, or movement
  • Any changes to mental status, such as consciousness, memory, or thinking
  • Weakness, numbness, tingling
  • Signs of infection including fever and chills
  • Redness, swelling, increasing pain, bleeding, or discharge from the incision site
  • Headache
  • Changes in vision
  • Fainting
  • Pain that you cannot control with the medications you were given
  • Persistent nausea or vomiting
  • Trouble controlling your bladder and/or bowels
  • Pain, swelling, or cramping in your legs
Call for emergency medical services 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 Canada http://biac-aclc.ca

Heart and Stroke Foundation Canada http://www.heartandstroke.ca

References

Cerebral aneurysm. American Association of Neurological Surgeons website. Available at: http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Cerebral%20Aneurysm.aspx. Updated August 2009. Accessed May 29, 2014.

NINDS cerebral aneurysm information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/cerebral%5Faneurysm/cerebral%5Faneurysms.htm. Updated April 16, 2014. Accessed May 29, 2014.

Neff D. Brain aneurysm. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated May 2, 2014. Accessed May 29, 2014.

Treatment of brain aneurysms. The Aneurysm and AVM Foundation website. Available at: http://www.taafonline.org/ba%5Ftreatment.html#ba%5Fclipping. Accessed May 29, 2014.

Williams LN, Brown RD Jr. Management of unruptured aneurysms. Neurol Clin Pract. 2013;3(2):99-108.

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