FAQ's on Aneurysm Surgery

Q- What is Aneurysm Surgery?

Ans- Aneurysm Surgery

Aims of the surgery include clipping the neck of the aneurysm to prevent re bleeding, to remove the clots – which decreases the severity of vasospasm and to do third ventriculostomy [alternative opening for CSF pathway] to decrease the chances of hydrocephalus

Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness, cerebral angiogram to access the anatomy of aneurysm and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will depend upon the intraoperative blood loss.

Once fit for procedure, a fasting period of 6 hours will be required for anesthesia.

Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breathe through a mask. Procedure involves a skin incision on the part of head corresponding to the aneurysm, creating a window through the skull bone, localizing the aneurysm and safe clipping of aneurysm.

Bone flap will be replaced and fixed. The wound is closed with or without drainage tube which is subsequently removed next morning. Anesthesia may be reversed in operation theatre or continued in the I.C.U. for brain protection.

Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a physiotherapist mobilization will be done. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Physiotherapist will assist and teach you manoeuvres which are to be continued even after discharge. Stitches may either be self-dissolving, subcuticular (buried) or may require to be removed six to eight days after surgery. Check CT scan will be done in post-operative period to confirm post operative status.

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

 1.1) Operative site bleeding – can produce haematoma and may require further surgery for removal if patient shows worsening in consciousness level or if the clot is significant.

1.2) Post-operative seizures – prevented by adequate anti-convulsants drugs.

1.3) Infection – meningitis– which may require injectable antibiotics for few weeks and prolong the hospital stay.

1.4) Developing fresh neurological defects – may not be related to surgery but more due to vasospasm. It is prevented post-clipping by maintaining adequate blood pressure to increase the blood supply to the brain. Inspite of all the efforts the chances of postoperative deficits is seen in nearly one-third patients which usually recovers over time in significant number of patients.

1.5) Chest infections  – particularly in elderly or patients who are bed ridden for long time.

1.6) Secondary complications due to bed ridden state.

1.7) Local wound infections – rare require antibiotics and local dressings.

1.8) Hydrocephalus – which may require a CSF diversion procedure like VP shunt.

1.9) Prolonged ICU may be required as delayed neurological complications may occur because of spasm of the blood vessels of the brain or hydrocephalus.

Generally life risk for patients undergoing surgery without any previous medical illness is 2 - 5 % and risk of complications is 10 to 15 % depending upon location of aneurysm and severity of bleed. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.