platesandsmallscrews(Figure8). halfwaterbeingsuretousecleancottonpads/balls.


Whatarethepossiblecomplications?
Possible risks and complications associated with this procedure include intraͲ
operative aneurysm rupture; major or perforating artery injury; retraction inͲ
jury;vasospasm;stroke;seizure;opticnerveinjury;vesselocclusion;andimperͲ
fectlyplacedclippossiblyrequiringreoperation.
Whathappensafterthesurgery?
After surgery, patients are first taken to the recovery room where they are
monitoredastheyawakefromanesthesia.Patientsarethentransferredtothe
IntensiveCareUnitforfurtherobservationandmonitoring.NauseaandheadͲ
achemaybeexperiencedaftersurgeryandthuspainmedicationsaregivenas
needed.  After 24 to 48 hours, you may be transferred to aneurological floor
wheremonitoringiscontinuedasyouregainstrengthandyourphysicalactivity
levelincreases.Upondischarge,mostpatientsareprescribedantiͲseizuremediͲ
cation, a precaution to prevent seizures after brain surgery. Several months
aftersurgeryanelectroencephalogramorEEGwillbepreformedtodetermine
if antiͲseizure medication should be continued.  Usually you will be given a
small breathing device called an ““incentive spirometer”” (Figure 9)  which you
x Donotputcreamorointmentonthestitches/staples.
x After surgery and during the healing process, it is normal for the scalp
andincisiontofeelnumband/ortobecomeflakyanditch.Rememberto
avoidscratchingtheareaasthiscancauseinfectionandpreventhealͲ
ing.
x Wound/incision pain and headache are also normal after the surgery.
Tylenol/TylenolExtraͲStrengthcanbetakenforthepain.
Whatistherecoverytime?
Typically, stitches/staples are removed 2 weeks after the procedure. HowͲ
ever,thisisageneralstandardtimeandisnotnecessarilythetimeinwhich
ColenSurgicalMediͲCard
all individuals heal. A followͲup office visit should be scheduled 4Ͳ6 weeks
aftertheprocedureinordertoobtainassessmentofthehealingandrecovͲ WhatisaCraniotomyforAneurysmClipping?
eryprogress. Acraniotomyforaneurysmclippingisadirectsurgicalprocedureperformedto
A detailed postͲoperative activity plan and  physical therapy / exercise plan treataballoonͲlikebulgeorweakeningofanarterywallknownasananeurysm.
willbegiventohelpeaserecoveryandreturntoahealthylifestyle.Patients Thetreatmentgoalofananeurysmclippingistoeitherpreventananeurysm
can generally resume normal activity in about 1Ͳ2 months after undergoing from rupturing or prevent further bleeding from a previously ruptured aneuͲ
craniotomy,butthisshouldbediscussedwithyourphysician. rysm.

A B

______________________________________________________________________

Ihavereadandunderstoodthecontentpresentedinthisbrochure.Allmyquestions
regardingthissurgicalprocedurehavebeenansweredsatisfactorily.

 Figure 1:Cerebralaneurysmisadilatationofthewallofanarteryinthebrain.
______________________________________________________________________
PATIENT’’SSIGNATURE     DATE
Disclaimer:Thecontentpresentedinthisbrochuremayvaryslightlyfromtheactual
surgicalprocedure. A B
Figure9:UsebybreathingͲindeeplyandmeasuringthevolumeofairyourlungscanhold. Developedby:
Repeatthisslowly,10timeseveryhour.

ColenPublishing,L.L.C.
canusetoexpandyourlungswhileinbed. FacultyReviewer:
Authors:
ChaimB.Colen,M.D.,PhD. SettiS.Rengachary,M.D.
PostͲoperativeCareoftheIncision RoxanneE.Colen,PAͲC EditorialFormatting: Figure2:A:TreatmentOption1:occludingtheaneurysmbyplacementofananeuͲ
x Donotremovethestitchesorstaples. Illustrations: KathrynSchwartz rysmclip;B:TreatmentOption2:endovascularplacementofacoilintotheaneurysm.
x You should shower but NOT bathe, until after the stitches or staples are AleemHussain,M.D.

ChelseaM.Smialek
KatharineVandePutte
ChaimB.Colen,M.D.,PhD.
removed(usually2weeksaftersurgery).
x Oncethestitches/staplesareremoved,hairmaybeshampooedhowever, Infinitepossibilitiestolearning…….
Whataretheindications?Whenisitused?
donotputhaircoloringorgelontheincisionsite. ColenPublishingisdedicatedtothepromotionanddisseminationofprofessionalmedicalbooks Ananeurysmcanbedifficulttodiagnoseasasmall,unchanginganeurysmwill
x If dissolvable stitches were used, a shower is permitted 5 days after surͲ andrelatedtopics.Throughourpublicationsweendorseandpropagateinnovativemedicaland produce no symptoms. However, as an aneurysm grows, the artery wall beͲ
gery. healthcareresearchandeducationwithinthecommunity.Visitusonthewebat:
comesthinnerandweaker,oftentothepointthatitleaksorruptures,releasing
x Theincisionmaybecleanedwithasolutionofhalfhydrogenperoxideand www.colenpublishing.com. blood into the spaces around the brain. This results in either a subarachnoid
hemorrhage(SAH)oranintracranialhematoma(ICH),bothofwhichconstitute
a stroke. When an aneurysm ruptures, an individual may experience sudden
symptoms that include severe headache, nausea/vomiting, fluctuations in the
heartbeat andbreathingrate, impaired vision, seizures, and loss of consciousͲ
ness.
Diagnosis of an aneurysm canbe difficult but is usually accomplished through
theuseofamagneticresonanceangiography(MRA),acomputedtomography
angiography (CTA) and/or contrast angiography (Figure 3). Such diagnostic inͲ
strumentsareusedtodeterminetheexactsizeandlocationoftheaneurysmor
subarachnoid hemorrhage. If a SAH is present, then a surgical clipping proceͲ
dure is performed within the first three days in order to occlude the rupture
andreducetheriskofreͲbleeding.

Whathappensduringsurgery?
Patients are given a general anesthesia to put them to sleep during the surͲ
gery.Abreathingtube(endotrachealtube)isplacedandthepatientbreathes
with theassistanceofaventilator.Aventilatorisadevice thatcontrolsand
monitors the flow of air into the lungs.  Preoperative intravenous antibiotics
aregiven.Thepatientispositionedontheirbackontheoperatingroomtable
with the neck kept in its usual position.  The surgical region (head area) is
cleansed with a special cleaning solution. Sterile drapes are placed, and the
surgical team wears sterile surgical attire such as gowns andgloves to mainͲ
tainabacteriaͲfreeenvironment.
Anincisionismadeoneithertherightorleftsideoftheheadaccordingtothe
locationof theaneurysm.Often,thisincisionismadebehindthehairlineto
minimizevisibility(Figure4).

Figure6:Openingtheduratoexposethebrain.

surgical scalpel is used to

carefully open the dura, reͲ
vealingthebrain(Figure6).
The operating microscope is
thenbroughtintotheoperaͲ
tive field to assist the surͲ
geon in locating the aneuͲ
rysm. Once the surgeon loͲ
Figure3:AͲHeadCTshowingsubarachnoidhemorrhage:BͲBrainangiogramdemonstrating cates the aneurysm, a clip is
aneurysm.
applied to the neck of the
aneurysm with meticulous
care (Figure 7). This secures
Whatarethebenefits? the aneurysm to prevent
Althoughtheaneurysmclippingprocedureisamoreclassicapproach,ithasits Figure4::Theheadispositionedina
rupture and bleeding. UnͲ
advantages over the newer endovascular aneurysm coiling procedure. Studies specialclamptoholdtheheadstable. Figure7:Thepertinentbloodvesselistracedtothe commonly, the aneurysm
haveshownthatindividualswhoundergoasurgicalclippingprocedurehavea aneurysm,andtheaneurysmclipped.
may rupture before or durͲ
decreasedriskoflateorrecurrentbleedandregrowth. ing an operation,  at which
HowwillIprepareforthesurgery? pointthesurgeonmayplace
PreparationbeforesurgeryincludesschedulingofpreͲsurgicaltests(bloodtest, Figure5:Boneremoved,exposing a temporary clip over the
electrocardiogram,chestxͲray)alongwiththecompletionandsigningofpaper dura. parent vessel to prevent
work and consent forms. Before surgery you should avoid using antiplatelet further bleeding. Even more
agents (such as aspirin, Plavix) or blood thinners (such as coumadin, heparin) rarely, this may cause the
An opening in the skull is
since these can increase bleeding during the operation.  Smoking is frowned patient to have a stroke
performed using a special
upon since it retards wound healing and should be stopped at least 2 weeks which is a known surgical
highͲspeed pneumatic drill,
priortotheoperation. risk.
removing the piece of bone
Onthedayofyoursurgery,youwillprobablybeadmittedtothehospitalearly Once all bleeding has been
toexposethedura(leathery
in the morning. You shouldn't eat or drink anything after midnight the night controlled, the brain is irriͲ
covering of the brain)
before your surgery. If you take any medications, discuss this fact with your gated with saline solution
(Figure5).
doctor. Figure8:Boneflapreplacedandsecuredwithmini and finally, the bone is reͲ
Once the dura is exposed, a
platesandsmallscrews. placedandsecuredwithmini