Clipping is a common surgical treatment for brain aneurysms because it is effective and has well documented results. The goal in clipping is to stop the likelihood of bleeding by placing a metal clip around the neck of the aneurysm which prevents blood from entering the sac. Over time, the aneurysm will shrink and scar down permanently, and the clamp stays in place for life. Depending upon location, an incision will typically be made behind the hairline or in the back of the head, and a small portion of hair will be removed where necessary. A section of the skull bone is removed by using a bone drill, and the dura (brain lining) is opened to gain access to the brain. Careful to avoid brain tissue the surgeon goes through the cleft between the skull and the brain. Once the aneurysm is located and separated from normal blood vessels, the clamp is put in place, and the procedure is complete.
Once again, the goal of this treatment is to block the aneurysm off from the blood flow to end the risk of rupture and bleeding without blocking off any small arteries nearby or narrowing the main vessel. The procedure begins with entering the body through the large femoral artery in the upper leg or groin area. A flexible catheter is advanced from the femoral artery to one of four arteries in the neck that lead to the brain. While viewing an x-ray monitor, called a fluoroscope, the surgeon steers the catheter through the blood vessels while a special dye is injected into the bloodstream making the blood vessels visible on the monitor. The result is roadmap of the arteries. Once the catheter reaches the aneurysm, a very thin platinum wire is inserted into it; the wire is also soft, so it coils up as it enters. Multiple coils are packed inside the dome to block normal blood flow from entering. Over time, a clot forms inside the aneurysm, effectively removing the risk of aneurysm rupture. Coils will remain inside the aneurysm permanently.
Embolization for Cerebral Arteriovenous Malformation (AVM)
Embolization is a treatment that has been in practice since the early 1980’s; this procedure involves injecting a glue -like or non-reactive liquid adhesive material into the AVM in order to block it off. In this process, a small catheter is passed through a groin vessel all the way up into the vessels that are supplying the AVM. The glue rapidly hardens as it is injected which results in closing it off and ending further risk of bleeding. Not all AVMs may be treated with embolization; they must first be carefully studied at the time of a preliminary angiogram to determine if the catheter can be passed up into the AVM without any complications. It should also be noted that many surgeons will recommend embolization as the first step in conjunction with another course of treatment, such as, radiation or another surgical procedure.
Resection of Cerebral Arteriovenous Malformation
AVM resection is an open surgical procedure where the surgeon creates an opening in the patient’s skull to allow for full visualization of the AVM. Once the skull is opened, the surgeon identifies the margins of the AVM and then clips the arterial vessels that feed it. The surgeon will remove or destroy the veins that drain the AVM and also the nidus (the direct connection of the arteries and veins). Endovascular embolization or radiosurgery may also be used in certain cases. Not all AVMs can be treated with surgery. Your surgeon will order tests, such as, a CT Scan or MRI, which tell him the size, and exactly where in the brain the AVM is located. Upon review, the surgeon will then decide if it is safe to remove without serious complications.