What is Microsurgical Aneurysm Clipping

Microsurgical clipping is a neurosurgical technique often performed through a craniotomy for patients with complex or wide-necked aneurysms. It is a very safe and effective procedure to treat or prevent brain aneurysm rupture. Microsurgical clipping achieves 99% long-term durability in preventing aneurysm recurrence.

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How is microsurgical aneurysm clipping recommended and performed?

Microsurgical aneurysm repair is performed through a craniotomy, which involves making a small incision in the hairline of the scalp and removing a small portion of the skull to access the aneurysm. The surgeon places a small titanium clip across the opening or “neck” of the aneurysm to stop or prevent blood flow. The skull is then closed and the incision is stitched. 

Surgeons often use a microscope and computer guidance during an open brain surgery to reach the precise location of the aneurysm.  

How long is the recovery after a neurosurgical clipping surgery?

Although the recovery time may be longer, aneurysm clipping is a safe and effective treatment option, with similar risks to endovascular treatment options. Most patients will be out of bed within 2 days, home within 2-5 days, and back to work in 4-6 weeks.

While generally safe and effective, the procedure requires general anesthesia and making into the patient’s skull. The incisions on the scalp may be sore and swollen for about a week after surgery and the incision may itch. Some patients experience headaches. It is recommended that you avoid heavy lifting and strenuous activities for up to 3 months and driving for about 3 weeks.

While uncommon, complications like seizures, vasospasm, or incision site infections can occur. 

When is microsurgical clipping recommended?

Craniotomy is often required for the surgical clipping of brain aneurysms that cannot be treated with endovascular coiling. Coiling and clipping are the two most common procedures used to treat brain aneurysms. 

Microsurgical clipping is often used for both ruptured and unruptured aneurysms. It involves placing a metal clip to cut off blood flow to the area of the aneurysm, preventing rupture or bleeding. 

Endovascular coiling is a minimally invasive procedure performed under general anesthesia, during which a catheter is threaded into an artery to reach the aneurysm where small metal coils are inserted to stop blood flow and reduce the risk of rupture or bleeding. Coiling is often preferred for patients who may not be suitable for open surgery or when the aneurysm is located in a difficult-to-access area. Recovery from coiling is generally quicker, with patients often returning to normal activities within a week. 

Case Studies: Microsurgical Aneurysm Clipping

Condition: Wide-necked, ruptured aneurysm in the right carotid artery (A).

Approach: Craniotomy and clip reconstruction. The aneurysm is bi-lobed and has a wide neck, making it more appropriate for surgical clipping as a definitive treatment. Due to the two lobes, the aneurysm required specialized clips and reconstruction of the carotid artery wall (B).

Outcome: Following successful clip placement, the aneurysm has markedly deflated in size

and no longer has any blood flow (C). The normal arterial wall was reconstructed and blood flow within all the normal surrounding arteries has been preserved.

Condition: Complex, non-ruptured aneurysm in the middle cerebral artery.

Approach: This complex aneurysm required the placement of three clips to “trap” the aneurysm, preventing all blood flow into the area. A bypass was not required since 

Outcome: All parts of the brain received adequate collateral blood flow after the aneurysm was trapped, and a bypass was not required.

While not all brain aneurysms require open surgery, microsurgical clipping remains the gold standard for complex aneurysms, offering unparalleled long-term durability and complete exclusion from blood flow. At New Jersey Brain and Spine, our expert neurovascular team combines decades of experience with cutting-edge technology to deliver exceptional outcomes for patients with challenging aneurysms.

If you’ve been diagnosed with a brain aneurysm or need a second opinion about treatment options, contact New Jersey Brain and Spine at 201-342-2550. Our specialists will evaluate your specific case and recommend the safest, most effective treatment approach. Schedule your consultation online or call to speak with our neurovascular team about how microsurgical clipping can provide you with lasting protection and peace of mind.
What is microsurgical clipping?