Supportive laparoscopic surgery to clamp the aneurysm neck

Aneurysm neck clamp surgery is the surest prophylactic treatment for intracranial cerebral aneurysms. This method completely blocks the blood circulation in the aneurysm without affecting the maternal vascular lumen, thereby significantly improving the outcome for the patient.

Spontaneous brain aneurysms occur in about 2% of the population and ruptured aneurysms are responsible for 3% of all strokes. Accordingly, when being diagnosed with a brain aneurysm, the patient always has to face a scary event that can happen at any time. If a brain aneurysm ruptures or bleeds, the condition can have life-changing consequences. However, if diagnosed early and treated successfully, the outcome and chance of a full recovery is quite good.
Therefore, the prophylactic treatment of early cerebral aneurysms is required with the requirement to safely occlude the brain aneurysm while preserving blood flow in the maternal vessels, pulse branches. around. For decades, this task has been achieved using classical open approaches, such as craniotomy. However, with the advent of endoscopic techniques and microscopy, interventional clamping of aneurysms has passed a new milestone.
Aneurysm neck clamp surgery has the principle to treat brain aneurysms by placing a small metal clip across the neck of the aneurysm. As a result, the site of the aneurysm is sealed from the blood stream, minimizing the risk of rupture or brain hemorrhage.

Laparoscopically assisted aneurysm clamping can be performed on a ruptured or unruptured aneurysm. In the setting of a ruptured brain aneurysm causing a hemorrhagic stroke (a serious medical emergency) neck clamping of a ruptured aneurysm is performed on an urgent basis. Accordingly, when going to the emergency department and determining the ruptured brain aneurysm, the patient will be taken directly to the operating room if the opportunity is assessed to perform an aneurysm clamp to save life and improve the prognosis in the future. .
In contrast, clamping an aneurysm when a brain aneurysm has not ruptured is not usually an immediate medical emergency. At this point, the patient has time to consult and plan treatment with the neurosurgeon. Often, an unruptured brain aneurysm is found incidentally or screened for in patients with a general family history of aneurysms.
Not all cases of an unruptured brain aneurysm require surgery to clamp the aneurysm. Only when an experienced neurosurgeon evaluates a patient at high risk of aneurysm rupture should primary prophylactic intervention be warranted. In cases where the risk of an aneurysm rupture is quite small, a better approach may be to monitor the aneurysm for any changes over time. If the increased risk of rupture is moderate or large, new surgical treatment may be indicated.

Aneurysm clamping is performed under general anesthesia. The patient is prepared for surgery as usual. On the scheduled surgery day, the patient was not on the operating table and was fixed in the head position, unable to move during the operation.
The surgeon then cleans the scalp but may not need to shave the hair. An incision is made completely behind the hairline (like a facial incision). The flap was then turned to the side, but the muscle layers remained unchanged. Continuing, a small bony opening is created above the eyebrow to provide a "window" to the inside of the skull, through which the brain parenchyma can be accessed.
Next, the surgeon opens the dura, the protective layer that surrounds the brain. The location of the aneurysm was determined by endoscopic technique. At this time, a significant volume of cerebrospinal fluid is drained, helping to open the surgical field for easier intervention.
At the same time, the surgeon controls the main blood vessel leading to the location of the aneurysm. Once the blood vessels are under control, the aneurysm is gently dissected from any surrounding structures, so that the entire neck of the aneurysm can be seen. This maneuver is especially careful to minimize brain trauma.
Once making sure not to clamp any other blood vessels, the surgeon places clamps over the entire neck of the aneurysm, which may require one or two clips to be used. The doctor will then check that the aneurysm is completely sealed to keep the clip in place permanently.
Finally, the endoscopic instruments will be withdrawn, the dura is closed with stitches. To close the opening into the skull, the surgeon uses thin metal plates and screws to reattach the small piece of bone that was removed at the start of the surgery. Like any other broken bone, the skull will heal on its own within weeks and months, growing back into a solid bone. The discs and screws may remain after the skull is healed, but do not need to be removed. The surgeon sutures the skin incision and the surgery is over.

The patient will be cared for in the postoperative department until fully awake before being taken to the rest room. The length of hospital stay after aneurysm clamp surgery varies widely, depending on whether the aneurysm ruptured prior to the procedure.
Specifically, patients with an unruptured aneurysm usually stay in the hospital for two days. After that, the patient is completely active as usual. In contrast, patients with ruptured aneurysms will stay in the hospital for 2-3 weeks, sometimes longer. During that time, patients are monitored for possible serious side effects after a bleeding in the brain, including cerebral vasospasm, hydrocephalus, heart and lung problems, or other medical conditions. other sequelae.
In summary, the use of minimally invasive methods for the treatment of brain aneurysms is constantly evolving. In particular, surgery to clamp the neck of aneurysms with laparoscopic support has achieved many high achievements, meeting the goals of patient safety and effective prevention of subsequent events. However, it is still important to detect brain aneurysms early and have an appropriate follow-up plan and timely intervene for the patient.