Microvascular occlusion clamps off the artery leading to an
. This prevents bleeding and rupture. Sometimes a bypass procedure is done as well, rerouting blood vessels to healthy areas of the brain. A portion of the skull is removed (called a
) and restored during this complex, open surgery.
Microvascular occlusion often treats a brain aneurysm that has ruptured and caused damage to the artery. It will not fix damaged areas of the brain, but it can improve quality of life by stopping bleeding.
An aneurysm is a weakened blood vessel in the brain that collects blood. The bulging, blood-filled pocket can put pressure on parts of the brain, pressing on nearby nerves. This can cause symptoms or cause the blood vessel to rupture (hemorrhage).
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Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: WeaknessNumbness or tinglingSpeech disturbancesVisual changesConfusion, memory lossSeizuresInfectionAdverse reaction to anesthesiaKidney damageBlood clotsRuptured aneurysm during surgery
Factors that may increase the risk of complications include: SmokingObesityHigh blood pressure
Discuss these risks with your doctor before the surgery.
Your appointment before the surgery may include: Physical exam, blood and imaging testsDiscussion of allergiesDiscussion of medications you are taking, including over-the-counter and herbal supplementsDiscussion of recent illness or other conditionsDiscussion of risks and benefits of treatment options
Before your procedure:
Imaging tests (ultrasound,
) may be done. Bring paperwork and scans to the hospital as directed.
Arrange for a ride home.No food or drink after midnight the night before the procedure.Discuss your medications with your doctor. You may be asked to stop taking certain medications before your procedure.
Women should let their doctor know if they are pregnant or planning to become pregnant.
will be used. It will block any pain and keep you asleep through the surgery.
The nurses and doctors will connect you to monitors to watch your blood pressure, heart rate, and pulse during the procedure. A catheter will be inserted to collect urine.
An IV will be placed in your arm for sedation and anesthesia. The nurse will shave an area of your head.
The doctor will perform a craniotomy, removing a small section of the skull to access the brain. X-rays and microscopic viewing will help the doctor find the artery leading to the aneurysm. The doctor will clamp off the artery. A bypass procedure (re-routing blood vessels toward healthy areas of the brain) may also be done.
The section of skull is replaced and the scalp is stitched back into place.
When the procedure is done, the catheter and IV will be removed. You will need to lie still for 6-8 hours or more. You will stay in the ICU, often for a day. Your blood pressure and other vitals will be monitored closely. You may be given medication for pain or other symptoms.
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
This complex procedure is done in a hospital setting. The usual length of stay is 4-6 days. Your doctor may choose to keep you longer if complications arise.
You will rest for several hours in the ICU.Nurses will monitor your vital signs.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as: Washing their handsWearing gloves or masksKeeping your incisions covered.
There are also steps you can take to reduce your chance of infection, such as: Washing your hands often and reminding your healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incision
When you get home, you may have to adjust your activity level while you recover. This may take 3-6 weeks. Home care may include: Resting when you need toCaring for the woundPhysical or rehabilitative therapy
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor: Any changes in physical ability, such as balance, strength, or movementAny changes to mental status, such as consciousness, memory, or thinkingWeakness, numbness, tinglingSigns of infection including fever and chillsRedness, swelling, increasing pain, bleeding, or discharge from the incision siteHeadacheChanges in visionFaintingPain that you cannot control with the medications you were givenPersistent nausea or vomitingTrouble controlling your bladder and/or bowelsPain, swelling, or cramping in your legs
Call for emergency medical services right away if any of the following occurs: SeizureShortness of breath or chest painLoss of consciousness
If you think you have an emergency, call for medical help right away.
Cerebral aneurysm. American Association of Neurological Surgeons website. Available at:
http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Cerebral%20Aneurysm.aspx. Updated August 2009. Accessed May 29, 2014.
Cowen J, Ziewacz J, Dimick J, et al. Use of endovascular coil embolization and surgical clip occlusion for cerebral artery aneurysms.
J Neurosurg. 2007;107:530-535. Available at:
http://thejns.org/doi/pdf/10.3171/JNS-07/09/0530. Accessed May 29, 2014.
Neff D. Brain aneurysm. EBSCO Health Library website. Available at:
http://www.ebscohost.com/healthLibrary. Updated May 2, 2014. Accessed May 29, 2014.
Treatment of brain aneurysms. The Aneurysm and AVM Foundation website. Available at:
http://www.taafonline.org/ba_treatment.html#ba_clipping. Accessed May 29, 2014.
Williams LN, Brown RD Jr. Management of unruptured aneurysms. Neurol Clin Pract. 2013;3(2):99-108.
Last reviewed May 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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