Craniotomy for Aneurysm Repair: Restoring Vascular Health in the Brain

October 8th, 2024 by New Jersey Brain and Spine

A brain aneurysm is a bulge or ballooning of a blood vessel in the wall of an artery in the brain. It is also known as a cerebral aneurysm or intracranial aneurysm. Experts believe aneurysms form and grow due to blood flow through a vessel that exerts pressure on a weak area of the vessel wall. Over time, the wall of the artery can bulge outward, forming an aneurysm sac. Aneurysm sacs are thin walled and may bleed if the wall of the aneurysm becomes too weak to contain the blood pressure.

Brain aneurysms occur in up to 3% of the population. Most brain aneurysms don’t rupture. However, a ruptured aneurysm quickly becomes life-threatening and requires medical treatment right away. If a brain aneurysm hasn’t ruptured, treatment may be appropriate in some cases to prevent a rupture.

What are the different types of brain aneurysms?

There are three known types of brain aneurysms. A saccular aneurysm, also known as a berry aneurysm, looks like a berry hanging from a vine. It’s a round, blood-filled sac that protrudes from the main artery or one of its branches. It usually forms on arteries at the base of the brain. A berry aneurysm is the most common type of aneurysm.

Next, there are fusiform aneurysms. These types of aneurysm cause bulging on all sides of the artery. Lastly, a mycotic aneurysm is caused by an infection. When an infection affects the arteries in the brain, it can weaken the artery wall. This can cause an aneurysm to form.

What are the different treatment options for brain aneurysms?

Small, unruptured brain aneurysms are often observed over time with MRIs. Some aneurysms do require treatment if the neurovascular surgeon believes the aneurysm has a high risk of rupturing and bleeding. Treatment options for brain aneurysms include aneurysm coiling, stenting or craniotomy and clipping of the aneurysm.

What is a craniotomy?

A craniotomy is a surgical procedure performed under general anesthesia. Often a microscope is used to perform the surgery. During craniotomy for aneurysm cipping, a small part of the bone from the skull is removed to expose the brain. The aneurysm is accessed from underneath the brain rather than “through” the brain. The patient’s own bone flap is replaced after the surgery has been done. Craniotomies for cerebral aneurysm treatment may use the guidance of computers to reach the precise location within the brain that needs to be treated.

How to treat a brain aneurysm through an open craniotomy

An open craniotomy to treat a brain aneurysm involves the removal of a small portion of the skull for access to the aneurysm. A craniotomy is performed by lifting the skin and muscles off the bone and folding them back. Next, small burr holes are made in the skull with a drill. The burr holes allow entrance of a special instrument called a craniotome. Similar to using a jigsaw, the surgeon cuts an outline of a bone window. The cut bone flap is lifted and removed to expose the protective covering of the brain called the dura. The bone flap is safely set aside and is replaced at the end of the surgery.

Clipping a brain aneurysm

Once the craniotomy is performed, the surgeon moves on to clipping the aneurysm. The goal of surgical clipping is to isolate an aneurysm from the normal circulation without blocking off any small perforating arteries nearby.

When clipping an aneurysm, a neurosurgeon opens the skull through the craniotomy and places a tiny clip across the neck of the aneurysm to stop or prevent it from bleeding. Neurosurgeons clip brain aneurysms to ensure they don’t rupture.

During surgery, the ballooned part of the vessel wall is closed off with a surgical clip. The brain is gently retracted to locate the aneurysm. A small clip is placed across the base—or neck—of the aneurysm to block the normal blood flow from entering. This clip operates similar to a tiny coil-spring clothespin—the blades of the clip remain tightly closed until pressure is applied to open the blades. Clips are made of titanium and remain on the artery permanently.

Once the aneurysm is repaired, it’s time to close the craniotomy. The bone flap is put back in its original position and secured to the skull with small titanium plates and screws.The plates and screws remain permanently to support the area, and they sometimes can be felt under the skin. A drain may be placed under the skin for a couple of days to remove blood or fluid from the area. The muscles and skin are sutured back together. A soft adhesive dressing is placed over the incision.

Craniotomy & Aneurysm Second Opinion Services in New Jersey

For more than 25 years, the experienced physician team at New Jersey Brain and Spine has delivered highly-skilled and compassionate care to more than 40,000 patients with complex brain, spine and neurological conditions. Please contact us today to decide if we are the right option for your care and treatment.

We also offer an expert second opinion service should you wish to discuss your treatment options. For more information, or to request a second opinion, reach out to us immediately by calling 201-342-2550 or emailing us at secondopinion@NJBrainSpine.com

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