CEREBRAL ANEURYSM SURGERY
A brain aneurysm is the ballooning of the wall of a blood vessel within the brain. This common type of aneurysm is known as a saccular or berry aneurysm. A cerebral aneurysm develops in an artery usually in the front part of the brain that supplies oxygen-rich blood to the brain tissue. They can however, develop anywhere in the brain’s arterial circulation and there may be multiple aneurysms.
Because there is a weakened spot in the aneurysm wall, there is a risk that this aneurysm may rupture, causing bleeding in the brain, which can quickly become life-threatening.
WHEN IS ANEURYSM TREATMENT NECESSARY?
For the most part, most patients are unaware they have aneurysms unless they rupture. A ruptured aneurysm can cause a severe headache as a result of a bleed known as a subarachnoid haemorrhage. This requires urgent treatment as there is significant risk of the aneurysm rupturing again. Some patients however, become aware of an aneurysm as an incidental finding following a brain scan for a reason not related to their aneurysm. In these circumstances, lots of factors such as the aneurysms size and location will be taken into account in working out the risk of an aneurysm rupturing and will be used to devise a treatment strategy.
HOW IS A BRAIN ANEURYSM TREATED?
Depending on the shape, size and location of the aneurysm, the type of treatment will vary. The strategies used for treating an aneurysm are endovascular treatment and surgical clipping.
Endovascular treatment – In Johannesburg, Dr Profyris works together with a very experienced interventional neuroradiologist. Together, they will make an optimal plan for treatment of your aneurysm. Endovascular treatment will involve puncturing the groin and passing a catheter to the arteries in the brain. There, the aneurysm will be detected and depending on the configuration of the aneurysm it will be treated with a coil, stent and/or a flow diverter.
Surgical clipping – In selected cases, surgical clipping will be the best option for treatment. Dr Profyris, in Johannesburg, South Africa is experienced with clipping aneurysms and uses keyhole and minimally invasive techniques to decrease the exposure of normal brain and thereby decrease morbidity and increase rate of recovery. He also uses ICG to visualise blood vessels during surgery. This procedure involves carefully dissecting the blood vessel with the aneurysm (bubble) and occluding it from the circulation with a titanium clip. Most aneurysm operations can be performed with incisions of about 5-6 centimeters.
This is a case of a large ruptured middle cerebral artery aneurysm operated on by Dr Profyris through a keyhole approach. This case was deemed a surgical case due to the size and location of the aneurysm. The green arrows on the left hand images demonstrate the aneurysm which has been occluded with the application of microsurgical clips, as can be seen by the images on the right. There is no flow of blood in the aneurysm following surgery meaning that the aneurysm is occluded from the circulation. The post-operative course was uneventful.
The following video demonstrates a case of a giant aneurysm operated on by Dr Profyris, which was deemed a surgical case. The aneurysm was secured and then opened so that the clot within the aneurysm could be evacuated as it was causing significant symptoms for the patient. The post-operative course was uneventful.
The following video demonstrates a case of an anterior communicating artery aneurysm causing sudden visual loss in a patient due to sudden expansion of the aneurysm and compression of the optic nerve. Surgery was deemed suitable in order to decompress the optic nerve. Dr Profyris operated on this patient through a keyhole approach and vision recovered instantly post-operatively with an uneventful recovery.
Any brain operation can be dangerous. The level of risk for a particular procedure will depend on many factors such as aneurysm location, aneurysm size and the condition of the patient. Our aim is to make every surgery as safe as humanly possible through meticulous pre-operative planning, application of keyhole techniques, obsessive attention to operative technique and application of multiple technologies. As this is highly variable Dr Profyris and his team will have a detailed discussion about the specifics of each case. Dr Profyris has significant experience with brain aneurysm surgery, He also has significant experience with complex cerebral aneurysm surgery
The answer to this is highly variable. The most important aspect of aneurysm surgery is safety. Depending on the exact location, type and size of aneurysm there can be a huge variation in time. With time ranges of an hour to many, many hours. The use of minimally invasive approaches and careful study of your aneurysm through pre-operative imaging can save significant time in theatre. As a high-volume vascular neurosurgery practice, we have significant experience with aneurysm and complex aneurysm surgery. Dr Profyris works with a highly skilled team and each case is evaluated for treatment for both endovascular and minimally invasive open techniques
Recovery is highly variable. However, the keyhole techniques that Dr Profyris utilises allow for faster recovery. Most patients are discharged from hospital after very few days and generally recover fairly quickly. Actual recovery will depend on factors such as aneurysm location, size and if the aneurysm has ruptured or not. Dr Profyris will have a detailed conversation with you about this.