Microvascular Occlusion Overview

Microvascular occlusion clamps off the artery leading to an aneurysm. This prevents bleeding and rupture. Sometimes a bypass procedure is done as well, rerouting blood vessels to healthy areas of the brain. A portion of the skull is removed (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

Also:

• Imaging tests (ultrasound, CT , MRI ) may be done before the procedure. Bring paperwork and scans from these tests to the hospital as directed.
• Arrange for a ride home.
• 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.

You may meet the neurosurgeon performing the procedure.

Women should let their doctor know if they are pregnant or planning to become pregnant.

Anesthesia

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

Description of the Procedure

The nurses and doctors will connect you to monitors to watch your blood pressure, heart rate, and pulse during the procedure. A catheter will be inserted to collect urine.

An IV will be placed in your arm for sedation and anesthesia. The nurse will shave an area of your head.

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 artery leading to the aneurysm. The doctor will clamp off the artery. A bypass procedure (re-routing blood vessels toward healthy areas of the brain) may also be done.

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 will be removed. You will need to lie still for 6-8 hours or more. You will stay in the ICU, often for a day. Your blood pressure and other vitals will be monitored closely. You may be given medicine for pain or other symptoms.

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. Anesthesia prevents pain during surgery. Pain or soreness after the procedure can be managed with pain medicine.

Average Hospital Stay

This complex procedure 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 in the ICU.

• Nurses will monitor your vital signs.

At Home

It will take at least 3-6 weeks to recover. When you return home, the following can help ensure a smooth recovery:

• Rest often.

• Keep your blood pressure under control.

• Clean the incision site as directed. Use a soft wash cloth to gently wipe the incision area and keep it dry.

• Take medicine as directed.

• Do rehabilitative therapy as directed.

• Be sure to follow 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 Foundtion website. Available at: http://www.taafonline.org/batreatment.html#baclipping . Accessed June 3, 2010.

Cowen J, Ziewacz J, Dimick J, et al. Use of endovascular coil embolization and surgical clip occlusion for cerebral artery aneurysms. J Neurosurg. 2007;107:530-535. Available at: http://thejns.org/doi/pdf/10.3171/JNS-07/09/0530 . Accessed June 4, 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.