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Operation of an aneurysm

  1. What is an aneurysm? (macroscopic and microscopic anatomy

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An aneurysm is defined as a dilatation located on part of a blood vessel; in this case it is the cerebral arteries, inside the meninges and the skull. Normally, the wall of a cerebral artery is made up of several layers: a thin, deep layer (the endothelium, the intima) used for exchanges between blood and brain tissue; it has no significant mechanical resistance against blood pressure. It is lined with a much thicker and stronger layer that contains muscle fibers and elastic fibers (the media). An aneurysm is formed from an area of the wall of the artery where the musculo-elastic layer is missing (the reason for this lack is the subject of research and discussion: several theories are under study, but congenital and sometimes hereditary factors intervene).From this area of “weakness” of the wall, under the force of arterial pressure, the thinnest layer makes “hernia” through the defect of the musculo-elastic layer (one can imagine that an aneurysm looks like a tube hernia on a tire), and an aneurysm is formed. It consists of a pocket, called “aneurysmal sac” in which the arterial blood under pressure circulates while swirling while its wall is very thin and fragile, and a “collar”, corresponding to the zone of passage between the artery and bag. Over time its size and shape can change, and the observed aneurysms have a diameter ranging from a few millimeters to several centimeters. Almost always, these aneurysms are located under the base of the brain, and in contact with a bifurcation of the artery.

  1. Treatment of the aneurysm: surgery.

Ivirtual clinicThere are 2 ways to treat aneurysms: embolization and surgery. In your case it is the surgery that is offered to you. The reasons for this choice were probably explained to you during the consultation with the neurosurgeon.  You will also need to be seen in anesthesia consultation before the procedure which will be entirely under general anesthesia. During this consultation, the anesthetist will explain everything about your anesthesia, especially the risks it presents.  It must be understood that this operation is only preventive , that its sole purpose is to prevent a catastrophic rupture of your aneurysm and that you will not get better after the operation than before. A priori your aneurysm is currently responsible for no symptoms, no improvement in your current state should be expected from this operation whose sole and only interest is that after, you will be safe from the risk of a break aneurysm.

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  2. an unruptured aneurysm usually does not cause any symptoms
  3. the main risk of an aneurysm is that of aneurysm rupture
  4. the break is usually not predictable and occurs suddenly
  5. rupture is accompanied by 50% mortality and 35% morbidity among survivors at this rupture
  6. the operation on the aneurysm is only preventive: it protects from rupture or a new rupture
  7. the aneurysm can be treated by surgery or embolization, both techniques involve risks, advantages and disadvantages
  8. in case of rupture it is much less dangerous to treat the aneurysm (despite the risks of the intervention) than not to treat it
  9. in the absence of rupture, there are risk factors for rupture (hypertension, smoking, family history) and the younger you are, the more it is justified to treat your aneurysm in order to protect you from a rupture .
  10. After the procedure you will lead a normal life, and your doctor will treat your hypertension and your vascular risk factors if necessary
  11. long-term follow-up with control arteriography at 5 years and then every 10 years is recommended.