Craniotomy for Aneurysm

Cerebral aneurysms typically occur at the branching points of cerebral arteries (see fig. 1). The goal of surgery is to eliminate the aneurysm from the arterial circulation – re-routing the blood supply to avoid the aneurysm, where the arterial wall can weaken or break. This can be accomplished by craniotomy and microsurgical exposure of the neck of the aneurysm. A spring-loaded clip is placed across the base (neck) of the aneurysm so blood can no longer flow into it. Many aneurysms have a complex shape and require specialized or multiple clip applications; some aneurysms cannot be clipped safely without causing a stroke.

Click here to view a movie concerning craniotomy for aneurysm.

A Patient's Story

While being evaluated for headaches, Phyllis Daughtery was diagnosed with two aneurysms, one on each of the right and left middle cerebral arteries. The right middle cerebral aneurysm was small and could be treated by an endovascular approach, but the left middle cerebral aneurysm was large (over 2 cm), complex, and not suitable for endovascular occlusion.

Arteriorgram (arrow to aneurysm).

She underwent craniotomy for clipping of the large aneurysm. Due to the location of branching arteries at the base of the aneurysm, total occlusion of the neck was not possible. However, it was possible to reduce the size of the aneurysm neck with clips, thus making a subsequent endovascular procedure an option.

Arteriorgram (arrow to remaing aneurysm).

The patient made a complete recovery from surgery and subsequently had endovascular occlusion of the residual left middle cerebral aneurysm as well as the untreated right middle cerebral aneurysm.

Arteriorgram (arrow to occluded aneurysm).