Microvascular Clipping Overview

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.

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 ) 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 will help the doctor find the exact weakened area of the brain. The aneurysm is separated from nearby healthy brain tissue. The doctor places a small titanium clip at the neck of the aneurysm, stopping blood from flowing. The clip stays in place permanently preventing, bleeding and/or rupture.

The section of skull is replaced, and the scalp is 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.
• Be sure to follow all of your doctor’s instructions.

RESOURCES:

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

Center for Vascular Surgery (INN)
http://neuro.wehealny.org/endo/proc_embolizations.asp

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

Hotchkiss Brain Institute
http://www.hbi.ucalgary.ca/

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_e/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/batreatment.html#baclipping . 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/cerebralaneurysm/detailcerebral_aneurysm.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.