Home > Procedures > Brain Surgery > Aneurysm Clipping

An aneurysm is defined as a bulge in a weak part of an artery. This  can be treated using a tried and tested procedure known as clipping or cerebral aneurysm clipping.

For patients with an aneurysm, the walls of the artery are under persistent pressure due to the high-pressure blood flowing in them. This continuous blood pressure can lead to ballooning out a weak portion in the artery, developing an aneurysm. This ballooning out may further result in bursting and leaking blood into the brain.

How is the procedure performed?

In the aneurysm clipping procedure, is performed by a neurosurgeon under general anaesthesia. The surgeon then makes an incision usually behind the patient’s hairline. Then a ‘window’ is created in the skull to enter the brain and reach aneurysm.

aneurysm clipping
Picture credit – Stanford Children’s Heath

The surgeon uses a microscope to have a close look at the aneurysm while treating. He or she will carefully separate the aneurysm from the brain and normal blood vessels. Then using a small metal clip, the blood supply to the aneurysm’s neck is blocked. This aneurysm clip stays in the patient’s body to prevent any rupture or bleeding in the future.

Who is a good candidate for surgery?

An aneurysm that has ruptured almost always needs intervention.

A patient who has an unruptured aneurysm is evaluated for the need for intervention by the neurosurgeon. This is based on consideration of risks and outcomes. The neurosurgeon will take into consideration the type, location, anatomical factors of the aneurysm and surrounding blood vessels when deciding to proceed with open surgery intervention. The other treatment option that is considered in treating an aneurysm is called coiling.

What are the risks associated with this procedure? 

Risk factors, side effects, and possible complications are mentioned as follows:

General risk factors associated with any brain surgery include:

  • Infection
  • Allergic reactions to anaesthesia
  • Stroke
  • Seizure
  • Swelling of the brain

Complications and risks related to aneurysm clipping specifically, include the following:

  • Vasospasm
  • Stroke
  • Blood clots
  • Seizure
  • Bleeding
  • Deterioration in vision and speech

An imperfectly placed clip can block a normal artery unintentionally. Or it may not properly block the aneurysm. This can result in a stroke or aneurysm re-bleed.

The patient may experience cognitive disability and memory loss. This is commonly observed after craniotomy for aneurysm clipping rather than after endovascular coiling in patients above 50 years old

Recovery from surgery

The patients who undergo aneurysm clipping, have to stay in the hospital for around 4 to 6 days after the procedure. You may need to be on medication for a short period to prevent seizures. Patients might feel fatigued and also have mild headaches in the recovery period. Please check with the local regulatory authority regarding restrictions on driving after craniotomy.

The success rate of aneurysm clipping and how long effects last?

A study, conducted on 116 consecutive surgically treated patients with 148 unruptured aneurysms was recorded and analyzed.

The procedure of aneurysm clipping reported 3.4% permanent morbidity and a mortality rate of 0.8%. This indicated that aneurysm clipping has the potential of a superior prognosis. This is when compared to the natural history of patients who have a life expectancy estimation of no less than 10 years.7

Clipping vs Coiling

  • Coiling or endovascular coiling involves a comparatively lower risk of complications like seizures as compared to aneurysm clipping in the short term. Though the advantages in the long term are uncertain. Coiling is a less invasive procedure when compared to craniotomy and clipping.
  • The coiling procedure involves some chances of more than one treatment session to decrease the chances of the aneurysm rupture. About 1 in 5 patients may need further treatment. But the aneurysm clip stays in the patient’s body permanently and therefore, prevents any rupture or bleeding in the future.
  • The coiling procedure is less invasive. Therefore the patient is sent back home after its complete, most likely in a day or two. The patients who undergo aneurysm clipping, have to stay in the hospital for around 4 to 6 days post-procedure.
  • After the coiling procedure, the recovery time is shorter. The patient usually recovers within a few weeks, but in aneurysm clipping, the recovery period may take longer. 6,8
Picture Credit – Surgical Units

Frequently asked questions

How long does aneurysm clipping surgery take?

The surgery usually takes around 3-5 hours or sometimes longer if a complex craniotomy is performed.

How long do aneurysm clips last?

The aneurysm clip stays in the patient’s body permanently and therefore, prevents any rupture or bleeding in the future.

Can a clipped aneurysm rupture?

There are chances of re-bleeding or rupture from a clipped aneurysm, but the probability decreases with time.

Do the aneurysm clips set off alarms in airports or metal screeners?

Its is always advisable to carry some documentation about your aneurysm surgery when travelling. However, the clips and coils used currently are unlikely to set off alarms in metal detectors.

Can you have MRI scans after aneurysm clipping?

Yes, these clips do not interact with the magnetic fields and hence you can go for MRI scans after the aneurysm clipping procedure. Some centres advocate avoiding MRI scans in the early post operative period.