Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation
CPT4 code
Name of the Procedure:
Surgery of Complex Intracranial Aneurysm, Intracranial Approach; Carotid Circulation
Common Names: Brain Aneurysm Surgery, Cerebral Aneurysm Clipping
Summary
This complex surgery involves accessing and repairing an aneurysm in the brain's blood vessels, specifically those connected to the carotid artery. Aneurysms are weakened areas in a blood vessel wall that can bulge or rupture, leading to serious health risks.
Purpose
Medical Condition: Intracranial aneurysm in the carotid circulation. Goals: To repair the aneurysm, prevent rupture, alleviate symptoms, and reduce the risk of stroke or other neurological complications.
Indications
- Symptoms such as severe headaches, vision problems, or neurological deficits.
- Diagnosed aneurysm in the carotid arteries via imaging tests.
- High risk of aneurysm rupture.
Preparation
- Fasting for a certain period before the surgery.
- Adjustments in medications (e.g., stopping blood thinners).
- Diagnostic imaging tests like MRI or CT angiography to evaluate the aneurysm.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A surgical incision is made in the scalp, and a section of the skull (craniotomy) is temporarily removed to access the brain.
- Aneurysm Access: Using microsurgical instruments, the surgeon carefully navigates to the aneurysm.
- Clipping: A small clip is placed at the base of the aneurysm to stop blood flow into it.
- Closure: The bone flap is replaced and secured, and the incision is closed.
Tools: Microsurgical instruments, surgical microscope, aneurysm clips, imaging guidance.
Duration
The procedure typically takes 3 to 5 hours.
Setting
Performed in a hospital, specifically in an operating room equipped for neurosurgery.
Personnel
- Neurosurgeons
- Surgical nurses
- Anesthesiologists
- Operating room technicians
Risks and Complications
Common Risks: Infection, bleeding, reaction to anesthesia. Rare Complications: Stroke, neurological deficits, aneurysm regrowth, or clipping failure.
Benefits
- Prevention of aneurysm rupture.
- Symptomatic relief.
- Reduced risk of stroke and neurological complications. Benefits may be realized within a few weeks post-surgery.
Recovery
- Initial recovery in the ICU for close monitoring.
- Pain management with medications as prescribed.
- Gradual return to normal activities over 4 to 6 weeks.
- Follow-up appointments for imaging and neurological assessments.
Alternatives
- Endovascular coiling: Less invasive but might not be suitable for all aneurysms.
- Watchful waiting: Regular imaging to monitor the aneurysm without immediate intervention, appropriate in low-risk cases.
Pros and Cons:
- Coiling Pros: Minimally invasive, shorter recovery.
- Coiling Cons: Less effective in preventing recurrence for certain aneurysm types.
- Watchful Waiting Pros: Avoids immediate surgery.
- Watchful Waiting Cons: Risk of rupture remains.
Patient Experience
During the procedure, the patient will be asleep and unaware due to general anesthesia. Post-surgery, there may be discomfort or pain managed with medications. Hospital stay features close monitoring, and recovery involves rest, gradual activity increase, and follow-up visits to track healing progress.