Some blood-vessel problems sit deep at the base of the brain, close to the optic nerves, the brainstem and the main arteries. Treating them calls for planned microsurgery, with continuous monitoring of the brain and nerves during the operation. This page covers open surgery for those vessel conditions; the choice between clipping and coiling is explained on the aneurysm page.
Who it may help
- A brain aneurysm that has ruptured or is considered at risk
- An arteriovenous malformation (AVM) near the skull base
- A cavernous malformation (cavernoma) that has bled
- A lesion that could not be treated from inside the vessel, or came back after such treatment
- Repeated bleeding or stroke-like episodes caused by a vessel abnormality
Conditions treated
- Aneurysms of the major arteries at the base of the brain
- Skull-base and deep AVMs
- Cavernous malformations
- Fusiform and giant aneurysms
- Brainstem vascular malformations
- Vascular problems after a brain bleed
How the operation is planned
- Imaging Angiography (DSA), MRI and CT angiography show the vessels and the lesion in three dimensions.
- Approach A pterional, subtemporal or retrosigmoid craniotomy is chosen depending on where the lesion lies.
- Monitoring Brain and nerve function are monitored throughout the operation.
- Check scan A scan after clipping or removal confirms that the lesion has been dealt with.
Before the procedure
- Complete vessel imaging
- Blood pressure control and a review of your medicines
- A detailed talk with the surgeon about risks and expected results
- Admission a day before surgery for preparation
Recovery: what to expect
- Two to three days in intensive care, with regular neurological checks.
- A hospital stay of about 5 to 6 days is usual.
- A scan within 24 to 48 hours of surgery and another at about 3 months.
- Rest at home for two to four weeks, depending on the operation.
- Rehabilitation if there is any weakness after a bleed.
These are typical timings. Your own plan depends on your condition, your general health and the operation chosen, and Dr. Chakraborty will go through it with you.
Risks to know about
Every operation carries risk. The ones most relevant here are:
- Stroke from a blocked or injured vessel
- Bleeding, swelling or infection
- Weakness, speech or vision problems depending on the location
- Seizures
- A need for further treatment if the lesion is not fully closed
Your own risks depend on your health and your scans, and are explained in detail before you decide on anything.
Common questions
What is the difference between clipping and coiling?
Coiling treats the aneurysm from inside the vessel through a catheter. Clipping places a small metal clip across the aneurysm during open surgery. Which is better depends on the size, shape and position of the aneurysm.
Will I need medicines for life?
Usually not. Blood pressure control is important, and anti-seizure tablets are often needed only for a limited time.
How serious is this surgery?
It is complex surgery, which is why it is planned carefully, with monitoring during the operation and intensive-care support afterwards. The risks for your particular case will be discussed beforehand.
When can I return to normal life?
Light daily activities usually resume within 2 to 3 weeks and work within 4 to 6 weeks, but this varies.
This page is general information to help you prepare for a consultation. It is not medical advice and does not replace an examination. Every plan is made for the individual patient.