Brain Aneurysm Clipping or Coiling

What Is a Brain Aneurysm?

A brain aneurysm is a bulge in a blood vessel in the brain. It is a potentially life-threatening condition that has the risk of rupturing. It occurs when there is increased pressure in a weak or thin area in the blood vessels, causing blood to pool in the area, and the brain bulges with the pooled blood. If it is left untreated, the brain aneurysm may leak or rupture, causing bleeding in the brain, known as a hemorrhagic stroke, which is a life-threatening condition and requires emergency management.

Brain aneurysms do not cause symptoms or health problems, especially when small. However, it requires treatment to avoid future complications. The common treatment choices for unruptured brain aneurysms are neurosurgical clipping and cooling. Before planning a treatment, it is necessary to understand the nature of brain aneurysms. Aneurysms can occur anywhere within the brain, and the shape, size, and location of the brain aneurysms play an essential role in planning the appropriate treatment.

What Is Aneurysm Clipping?

Aneurysm clipping is a surgical procedure in which the blood vessel is directly accessed by removing a part of the bone from the skull to look at the brain, and a metal clip is placed at the base of the aneurysm, aiding in cutting off the blood supply from the aneurysm. This surgical procedure mainly aims to isolate an aneurysm from normal circulation without damaging small perforating adjacent arteries. This procedure prevents the blood from flowing into the weakened pouched area, thereby reducing the risk of future rupture. The clips used for the procedure are made of titanium and remain permanently on the artery.

The surgery is carried out under general anesthesia and has the following steps:

• An incision is made in the scalp, or in some cases, just above the eyebrow, and a small piece of bone is removed to get better access to the brain.

• After exposing the brain, the aneurysm is located and isolated from the surrounding blood vessels.

• Then, a small metal clip made of titanium is carefully placed around the aneurysm's neck and secured. This prevents blood flow into the weakened area.

• After clipping, the skull is closed by replacing the bone flap and sutured. Close monitoring of the patient during the recovery period is needed.

• After the procedure, the blood vessel lining will heal gradually where the clip is placed. This will permanently seal the aneurysm and prevent it from growing or rupturing.

What Are the Pros and Cons of Aneurysm Clipping?

Pros of Aneurysm Clipping:

• Longstanding and Safe Procedure - This procedure is safe, effective, and durable and has been used for decades in treating aneurysms. Studies on clipping have been conducted in many patients, and the required changes have been made for even better outcomes.

• Immediate Protection - Clipping surgery provides immediate protection for most aneurysm cases, even if ruptured. The clipping procedure can also be used for cases considered difficult to treat, for instance, an aneurysm with a wide neck at the base.

• Reduced Recurrence Risks - There is an extremely low chance of recurrence in well-clipped aneurysms. The chance of recurrence is safe even for complex aneurysms or those located in challenging anatomical regions.

Cons of Aneurysm Clipping:

• Invasive Procedure - Clipping is an invasive procedure that requires open brain surgery. To clip placement, the surgeon removes a portion of the skull cut into brain tissues to access the aneurysm.

• Prolonged Recovery - As clipping is an open brain surgery, the recovery time will also be longer when compared to coiling.

• Risk of Complications - As with any surgical procedure, there are risks of complications such as infection, bleeding, and adverse reactions to anesthesia.

What Is Aneurysm Coiling?

Coiling is an endovascular surgical procedure. It is carried out under general anesthesia, and the surgeon accesses the aneurysm with the vascular system. The procedure involves making an incision in the thigh or groin. The surgeon uses X-ray imaging and a special dye which will help in monitoring the blood vessels, up into the brain and aneurysm.

After placing the catheter in place, tiny platinum coils are passed through the tube to reach into the aneurysm. This process is continued until the aneurysm is full by compressing it into a small metal ball. Blood cannot enter the bulge after filling the aneurysm with the coil. A clot will form around the coils, making it hard for blood to enter the aneurysm, thereby reducing the rupture risk.

What Are the Pros and Cons of Aneurysm Coiling?

Pros of Aneurysm Coiling

• Less Invasive Procedure - It requires only a single incision to access the artery; therefore, it does not require opening the skull or brain.

• Shorter Recovery Time - Coiling requires only one incision, so the recovery is faster with no complications than clipping.

• Safer Than Clipping - As clipping is an invasive procedure, it may carry risks for older adults or those with certain health conditions. Coiling, being a minimally invasive procedure, is a safer option for high-risk patients.

Cons of Aneurysm Coiling

• Not Suitable for All Aneurysms - Coiling may not be suitable for certain types of aneurysms, mainly those with wide necks, complex shapes, or ruptured.

• Long-term Effectiveness - There is a possibility of reopening or recurrence over time.

• Risk of Complications - As with any surgical procedure, there are potential risks, including coil migration, blood clot formation, or rupture of the aneurysm during or after coiling.

• Requires Additional Procedures -In some cases, coiling alone may not be effective in treating aneurysm. Additional coils, balloons, or stents may be needed to effectively treat an aneurysm to keep blood vessels open and support the coiling.

Which Is Better: Clipping or Coiling?

The decision between clipping and coiling is complex and depends on several factors, such as the aneurysm's size, location, and shape.

Healthcare professionals may choose a procedure by weighing its risks and benefits:

• Aneurysm Size and Shape: For larger aneurysms and aneurysms with wide necks, clipping is an ideal option. Coiling may be ideal for small to medium-sized aneurysms with a narrow neck.

• Rupture: For ruptured aneurysms, immediate treatment is required with surgery to remove blood and relieve pressure on the brain. In such cases, the surgeon can clip the aneurysm simultaneously.

• Patient's Health and Preferences: The patient's overall health, other health conditions, and personal preferences can influence the treatment choice. Some patients may prefer the less invasive coiling, while others may prioritize the durability of clipping.

Conclusion:

Clipping and coiling are two effective treatments for brain aneurysms. The most crucial thing in managing brain aneurysms is the treatment choice, which may depend on size, location, and shape. Also, each method has advantages and disadvantages, and the choice between them is highly individualized. Patients should discuss the most effective treatment with no complications and a speedy recovery with their healthcare professionals.