61702 Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation

Name of the Procedure:

Surgery of Simple Intracranial Aneurysm, Intracranial Approach; Vertebrobasilar Circulation

Summary

This surgical procedure aims to treat an aneurysm located in the vertebrobasilar circulation of the brain. An aneurysm is a weakened area in the wall of a blood vessel that causes it to bulge or balloon out. This surgery involves accessing the aneurysm through an intracranial, or within-the-skull, approach to secure and repair the weakened vessel.

Purpose

The primary goal of this procedure is to prevent the aneurysm from rupturing, which can lead to hemorrhagic stroke, brain damage, or even death. By repairing the aneurysm, the procedure aims to restore normal blood flow and reduce the risk of serious complications.

Indications

The surgery is indicated for:

• Patients with a diagnosed unruptured aneurysm in the vertebrobasilar circulation.
• Symptoms such as severe headache, neurological deficits, or cranial nerve dysfunction.
• Risk factors like family history of aneurysms, high blood pressure, or previous aneurysm rupture.
• Imaging tests confirming the presence and size of the aneurysm.

Preparation

• Fasting from midnight before the day of surgery.
• Adjustments to medication, such as blood thinners, as advised by the surgeon.
• Pre-operative imaging studies like CT or MRI angiography to map the aneurysm.
• Blood tests and physical exam to ensure overall readiness for surgery.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free.
2. Incision: A surgical incision is made in the scalp and the skull is accessed.
3. Accessing the Aneurysm: Specialized instruments are used to navigate to the aneurysm site in the vertebrobasilar circulation.
4. Clipping the Aneurysm: A tiny metal clip is placed across the neck of the aneurysm to stop blood flow into the bulge.
5. Closure: Once the aneurysm is secured, the incision is closed, and the skull bone is replaced.

Duration

The procedure typically takes between 3 to 5 hours, depending on the complexity and location of the aneurysm.

Setting

This surgery is performed in a hospital operating room equipped with advanced neurosurgical technology.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians
• Radiologic Technologist (if intraoperative imaging is used)

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Stroke
• Neurological deficits such as vision loss or muscle weakness
• Anesthesia-related complications

Benefits

Successful repair of the aneurysm significantly reduces the risk of rupture and subsequent hemorrhagic stroke. Patients can expect to return to normal activities over time, with improvement in symptoms if any were present pre-surgery.

Recovery

• Initial recovery in ICU for close monitoring.
• Pain management with medications.
• Gradual return to normal activities over weeks to months.
• Follow-up appointments for imaging studies to ensure ongoing stability of the aneurysm site.

Alternatives

• Endovascular coiling: A minimally invasive procedure where coils are placed inside the aneurysm via a catheter.
• Medical management and monitoring, especially for smaller aneurysms deemed lower risk.

Each alternative has its advantages and limitations. Endovascular coiling is less invasive but may not be feasible for all aneurysm locations or shapes.

Patient Experience

Patients will be under general anesthesia during the procedure, so they won't feel anything during the surgery. Post-operatively, patients may experience headaches, surgical site pain, and temporary neurological symptoms, which are managed with pain relief and supportive care. Comfort measures include appropriate pain medication and monitoring for any complications.