Brain Aneurysm Surgery: What to Expect on the Day of Surgery

If you are having brain aneurysm surgery, the day of your operation can be exhausting for you. You might be going into an appointment for a prophylactic brain aneurysm repair or you may be having surgery to repair a ruptured brain aneurysm and to minimize its consequences.

You and your family will be provided with information about your surgery before, during, and after the procedure. It can also help if you know what to expect. 

In the days prior to your brain aneurysm surgery, you may already have had brain imaging tests and blood tests in preparation. Some diagnostic tests may need to be repeated on the day of surgery.

Before the Surgery

If you are having a prophylactic brain aneurysm repair, you could be coming to your appointment from home. You will go to a preoperative area where you will have an intravenous (IV, in a vein) line placed into your hand or arm. 

If you are already in the hospital, you may be going to surgery from the intensive care unit (ICU) or from the emergency room, and you would already have an IV in place. 

You will have monitors to track your blood pressure, respiratory rate, and pulse. A pulse oximeter will be placed on your finger to monitor your oxygen saturation. You might also have a urinary catheter placed prior to your surgery. 

Before your surgery, your anesthesia will be started and your incisional area will be cleaned.

Cleaning the Surgical Area 

If you are having an endovascular brain aneurysm repair, you would have a surgical drape placed over your body, with exposure of a small area of your groin, above the femoral artery. You would have the skin cleaned with a surgical antiseptic solution in the area where your healthcare provider will insert a catheter (thin surgical tube) into your femoral artery. 

For a craniotomy (removal of a portion of your skull for surgical access), your body and face will be covered with a surgical drape, and the surgical area on your head will be exposed. Your hair will be shaved and the skin on your scalp will be cleaned with surgical solution in preparation for your scalp incision. 

Anesthesia 

For an endovascular procedure, may have general anesthesia or anesthesia sedation with local anesthesia. If you are having a craniotomy, you would have general anesthesia and respiratory breathing assistance during your surgery.

When you have local anesthesia, the anesthetic medication would be injected into your skin near the incision site. You will also receive anesthetic medication in your IV to make you sleepy.

You may remain awake and drowsy during your endovascular surgery, and you might fall asleep. 

For general anesthesia, you would have medication injected into your IV that puts you to sleep, prevents muscle movement, and prevents pain. You would also have a breathing tube inserted into your throat so that a machine can help you breathe during your surgery.

During the Surgery

Throughout your surgery, you will continue to have your blood pressure, pulse, oxygen saturation, and respiratory rate monitored. 

Your healthcare provider will start your surgery by making an incision and then accessing your aneurysm. The process for a brain aneurysm repair with a craniotomy is different than the process for an endovascular procedure.

Endovascular Repair

For an endovascular repair, your healthcare provider will make a small incision in the skin in your groin near your femoral artery:

• The catheter will be placed into the artery.
• With real-time imaging guidance, your healthcare provider will advance the catheter carefully to the aneurysm in your brain.
• With imaging guidance, a small metal coil that is attached to the catheter will be placed into the aneurysm to prevent blood from flowing though the defective area. This prevents the aneurysm from bleeding and leads to eventual degeneration of the defect.
• You may also have a stent placed in the artery to maintain optimal blood flow.

Once the coil and/or stent is in place, the catheter will be carefully removed, also with the assistance of imaging.

Your healthcare provider will place one or more absorbable sutures in the femoral artery, and one or more sutures to close the skin incision. You will have your surgical wound covered with surgical dressing and bandages. 

Craniotomy 

For a craniotomy, your surgeon will make an incision into the skin on your scalp:

• A surgical drill is used to remove a portion of the skull.
• After the bone is removed, the meninges, a protective covering that lies immediately adjacent to the brain, will be cut as well. 
• Your surgeon will access your aneurysm and may stitch or place a clip on the aneurysmal defect. The repair prevents blood from entering into the weak, defective outpouching. Eventually, the defect will degenerate, and the blood can flow though the artery without risk of rupture. 
• If you have had a bleeding aneurysm, your surgeon will remove blood from around your brain. Blood from a bleeding aneurysm is often located in the subarachnoid area, deep around the brain. 
• You may have a surgical shunt (tube) placed near your brain tissue if you have a high risk of post-operative edema (swelling). The shunt, which drains fluid to the outside of your body, will eventually be removed.

After your aneurysm is repaired and blood is removed, your meninges will be repaired. You might have the portion of bone that was removed positioned back in place on your skull. This will eventually heal.

Sometimes, a craniectomy is done, in which the bone is not replaced until several days or weeks after surgery—when edema subsides. 

You will have the skin incision in your scalp closed and covered with surgical dressing and bandages. 

Discontinuing Anesthesia 

After surgery, your anesthesia will be stopped or reversed. If you have mechanical respiratory assistance, your breathing tube might be removed if your surgical team determines that you are ready to breathe on your own. Sometimes, respiratory assistance must be continued after brain aneurysm surgery is complete. 

After the Surgery

You will then go to a postoperative recovery area or to the ICU. You will likely be very drowsy or sleepy. 

You can expect to be more alert and interactive after a prophylactic surgery, especially if it is an endovascular repair, and more tired after brain aneurysm surgery that is done for treatment of a ruptured cerebral aneurysm.

You will be closely monitored, and your healthcare providers will frequently check your alertness, movements, eyes, and reflexes with neurological examination. If you have a drain in place, your medical team will manage the device and the fluid. 

You may need adjustments of your IV fluids, blood pressure medication, or supplemental oxygen. You might receive steroids, anti-seizure medication, or other medications.

If you are awake and ready to eat, take a few steps, or use the toilet, you can do these things with assistance. You will receive pain medication if you need it. 

A Word From Verywell

When you or a loved one is having brain aneurysm surgery, the day can feel long and uncertain. If you are having brain aneurysm surgery, you will feel groggy, and you might sleep the whole day.

You will also have a number of medication adjustments throughout the day to optimize your surgical outcome. And you would be monitored very closely in the hours after your surgery so that any complications can be identified and treated right away.