Brain Aneurysm Surgery: How to Prepare

Brain aneurysm surgery may be done as a planned prophylactic operation or on an emergency basis. Preparation often involves visualization of the aneurysm with brain imaging studies, consideration of the likelihood of aneurysm-associated health problems, surgical risk assessment, and preoperative management of medical issues such as hypertension.

You will be involved in the preparation prior to having a prophylactic aneurysm surgery. Emergency brain aneurysm surgery is done as a lifesaving intervention and therefore preparation may not be possible.

Location

The location of your brain aneurysm surgery depends on the type of procedure you are having. Brain aneurysms (also referred to as cerebral aneurysms) can be repaired in a hospital operating room or in an endovascular procedural suite. 

Minimally invasive endovascular aneurysm surgery is done with a catheter (special surgical wire) that is inserted into an artery and advanced to the aneurysm. This minimally invasive type of repair requires imaging and endovascular equipment, and it may be done in either a surgical operating room or a procedural suite.

Surgery that involves a craniotomy (removal of a portion of the skull for surgical access) is done in an operating room.

What to Wear

You can wear anything comfortable to your surgery appointment if you are having a prophylactic brain aneurysm repair. 

If you are having an endovascular procedure, you will have a catheter inserted into an artery in your groin. You should make sure that you will wear pants or a skirt with a loose fit to avoid excessive pressure on the wound after surgery.

If you are going to have a craniotomy, you can wear anything you would like to the surgery. You should know that a portion of your scalp will be shaved before surgery. After surgery, you can wear a loose-fitting hat or scarf to cover the wound and bald spot if you would like—but you cannot wear something tight on your head.

Food and Drink

For an endovascular brain aneurysm repair, you will likely have anesthesia sedation, which may not require adjusting your food and drink prior to surgery. 

If you are having a prophylactic craniotomy, you will have general anesthesia. This means that you will need to fast from food and drink beginning the night before your surgery.

If you are having an emergency craniotomy, you might not be able to fast the night before your surgery. While you are in the hospital for management of a ruptured brain aneurysm, you would be directed to avoid food and drink in the hours leading up to your emergency surgery. During this time, you would receive intravenous (IV, in a vein) fluids.

Medications

Before having brain aneurysm surgery, you may need certain medications and medical treatments, or you could be instructed to adjust some of your regular medication doses.

If a brain aneurysm ruptures, careful management of fluids, blood pressure, and cerebral edema (swelling in the brain) is crucial. These issues can affect recovery from a brain aneurysm rupture, as well as surgical recovery.

Preoperative medications and treatments you may need include: 

• Blood thinners: If you regularly take a blood thinner, your healthcare provider may instruct you to stop taking it or may adjust your dose for a few days. This adjustment would be necessary before either a prophylactic brain aneurysm surgery that’s done as a craniotomy or an endovascular repair.
• Anti-hypertensive medication: If you have hypertension, you may need anti-hypertensive medication to lower your blood pressure before having prophylactic brain aneurysm surgery. Blood pressure management helps prevent brain aneurysm rupture, and it helps prevent certain surgical complications.
• IV fluid: If you have had a ruptured brain aneurysm, you will receive IV fluid that includes the precise concentration of water and electrolytes that you need to help manage your blood pressure and to prevent cerebral edema.
• Steroids: Often, steroid medications are given to reduce the cerebral edema that can occur due to a bleeding aneurysm before emergency brain aneurysm surgery.
• Blood pressure medication: In the days immediately after a brain aneurysm rupture, your blood pressure can fluctuate substantially. You may need a delicate balance of blood pressure medications to lower your blood pressure or to raise your blood pressure.
• Anticonvulsant: A ruptured brain aneurysm may lead to seizures. Anti-seizure medication may be necessary before, during, and/or after brain aneurysm surgery. 

Respiratory Support

A ruptured brain aneurysm can lead to increased pressure in the brain due to bleeding and cerebral edema. This can impair breathing or may cause respiratory failure, which is life threatening impairment in breathing.

You may need respiratory support to prevent an oxygen deficiency, which can worsen the chances of recovery.

• Supplemental oxygen: If you are breathing on your own but have a low oxygen saturation, you may need oxygen supplementation while you are waiting for surgery. 
• Mechanical respiratory support: If your breathing becomes severely impaired due to the effects of a brain aneurysm rupture, you may need to have mechanical breathing assistance before you have surgery. 

What to Bring

When you go to your surgery appointment for a prophylactic brain aneurysm repair, you should bring a form of personal identification and your health insurance information. 

If you are going to have a prophylactic brain aneurysm surgery, you should have someone with you who can drive you home when you are discharged from the hospital.

If your healthcare providers tell you that you should anticipate a prolonged hospital stay or a stay in a rehabilitation facility, you may benefit from bringing some of your familiar belongings with you, such as your eyeglasses or dentures.

Pre-Op Lifestyle Changes

Before having a prophylactic brain aneurysm surgery, you will be advised to stop smoking if you smoke. Smoking is associated with a risk of brain aneurysm rupture, which would cause more severe and lasting problems than an unruptured cerebral aneurysm.

Certain drugs of abuse, such as cocaine and methamphetamine, may also increase the risk of your brain aneurysm rupturing. You would be advised to stop using these drugs if you use them.

A Word From Verywell

If you are having prophylactic brain aneurysm surgery, there are several things you need to do in advance to maximize your chances of having a good outcome. And if you need emergency brain aneurysm surgery, you will have very close medical care in the hours or days leading up to your surgery—which will help prepare you for your operation and help minimize the health consequences of a ruptured brain aneurysm.