Microsurgery is performed under a high magnification operating microscope and neuro-endoscope (a tubular instrument with a built-in video camera). The process also involves a team of neuro-anesthesiologists, and neurophysiologists who monitor the brain during microsurgery.

Brain monitoring is conducted using Doppler and Angiographic scans that ensure the adequacy of aneurysm clipping and to confirm that adjacent branch arteries remain open and unblocked.

Microsurgical treatment consists of a craniotomy, which involves the removal of the skull base bone to expose the aneurysm. Once the aneurysm is exposed, non-magnetic titanium clips are used to treat the aneurysm.

Another microsurgical approach is to perform brain artery bypass to exclude the aneurysm from circulation.

The initial treatment of the aneurysm by endovascular coiling or clipping is only a part of the management needed to optimize recovery for patients with Subarachnoid Hemorrahge (SAH).

The patient’s problems often include brain injury from the initial hemorrhage, vasospasm of the brain arteries, hydrocephalus, hyponatremia (low sodium concentration in the blood) and other medical complications. The patients are monitored and treated for several days in the Neuro Intensive Care Unit by team of experienced, capable and compassionate nurses, physicians, and other health care professionals.

In addition to monitoring cardiac, cerebrovascular, and neurological parameters, patients are evaluated by transcranial Doppler evaluation and Single Photon Emission Computed Tomography (SPECT) scanning for the occurrence of vasospasm, which is the sudden constriction of a blood vessel, causing a reduction in blood flow.

When present and clinically relevant, patients are treated medically with hypertensive, hypervolemic, hemodilutional (HHH) therapy, and frequently by Endovascular Angioplasty.

Patients with SAH caused by aneurysms often require neurological and psychological rehabilitation to enable them to become independent, and return to their former activities.

The Aneurysm Management Team at HMC assist the patients in achieving their maximal recovery potential. Sometimes, the recognition of persisting hydrocephalus and treatment by a ventriculo-peritoneal shunt may improve the patients functional recovery dramatically. In other instances, adjustment of the patients’ medication, or finding the right rehabilitation facilities may make a great difference to the patients.