Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation
CPT4 code
Name of the Procedure:
Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation
- Common names: Brain aneurysm surgery, Clipping of intracranial aneurysm
- Technical terms: Intracranial aneurysm clipping, Craniotomy for aneurysm repair
Summary
This procedure involves surgically accessing the brain to repair a weakened area in a blood vessel (aneurysm) within the carotid circulation. The aneurysm is clipped to prevent it from rupturing and causing a hemorrhage, which can be life-threatening.
Purpose
The surgery aims to treat and prevent the rupture of an intracranial aneurysm located in the carotid circulation, which can lead to severe complications such as stroke, brain damage, or death. The primary goal is to secure the aneurysm, thereby preventing a brain hemorrhage.
Indications
- Aneurysms that have been diagnosed through imaging and are at risk for rupture
- Patients experiencing symptoms such as headaches, neurological deficits, or cranial nerve dysfunction due to the aneurysm's pressure
- Cases where the size or shape of the aneurysm increases the risk of rupture
Preparation
- Patients will need to fast for at least 8 hours before the procedure.
- Medication adjustments, particularly blood thinners, may be required.
- Pre-operative diagnostic tests often include MRI, CT scans, and angiograms to precisely locate and assess the aneurysm.
- A meeting with the surgical team and anesthesiologist to discuss the procedure and anesthesia plan.
Procedure Description
- The patient is placed under general anesthesia.
- A craniotomy is performed, where the surgeon makes an incision in the scalp and removes a section of the skull.
- The brain is carefully navigated to locate the aneurysm.
- A metal clip is placed at the base of the aneurysm to stop blood flow into it, effectively securing it.
- The bone flap is replaced, and the scalp is sutured closed.
- An intraoperative angiogram may be performed to ensure the aneurysm is fully secured.
Equipment used includes:
- Microsurgical instruments
- Surgical microscope
- Intraoperative Doppler ultrasound
- Clipping devices
Duration
The procedure typically takes between 3 to 6 hours, depending on the aneurysm's complexity and location.
Setting
This surgery is performed in a hospital setting, specifically in an operating room equipped for neurosurgical procedures.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Neurophysiologist (optional, for monitoring brain activity)
Risks and Complications
- Common: Bleeding, infection, blood clots, and adverse reactions to anesthesia.
- Rare: Stroke, brain swelling, seizures, neurological deficits, or a need for additional surgeries.
Benefits
The primary benefit is the prevention of aneurysm rupture, significantly reducing the risk of a life-threatening hemorrhage. Patients may experience immediate relief from symptoms caused by the aneurysm's pressure once it is secured.
Recovery
- Post-procedure, the patient will be monitored in the ICU for several days.
- Instructions include managing pain, avoiding strenuous activities, and adhering to medication schedules.
- The overall recovery period can range from several weeks to a few months, with regular follow-up appointments to monitor healing and assess neurological function.
- Physical therapy may be required to assist in recovery.
Alternatives
- Endovascular coiling, a less invasive procedure where coils are placed within the aneurysm through a catheter.
- Observation and medical management for small, asymptomatic aneurysms.
- Pros and cons involve considering invasiveness, recovery time, and the aneurysm's risk profile.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any discomfort. Postoperatively, they might experience headaches or soreness at the surgical site. Pain management will be provided, and measures will be taken to ensure comfort during recovery.