A brain aneurysm is a weakened, bulging spot on the wall of an artery in the brain, carrying the risk of rupture and subsequent bleeding. When treatment is necessary, the duration of the surgical procedure is a common question. The total time spent in the operating room varies significantly, depending primarily on the specific method chosen to secure the aneurysm. This surgical duration is the first part of the overall timeline, which also includes extensive immediate post-procedure monitoring.
Surgical Duration Based on Procedure Type
The two primary methods for treating a brain aneurysm are endovascular coiling and open surgical clipping. Endovascular coiling is a minimally invasive procedure, performed by inserting a catheter through the femoral artery and guiding it up to the brain. Small platinum coils are threaded into the aneurysm to block blood flow. The coiling procedure itself generally takes about one and a half to three hours to complete. Including patient preparation and recovery from anesthesia, the total time in the procedure room often ranges from two to four hours.
Surgical clipping is an open-brain surgery that requires a craniotomy, which is the temporary removal of a section of the skull. This technique involves dissecting the brain tissue to expose the affected blood vessel and placing a tiny metal clip across the neck of the aneurysm. Because the skull must be opened and closed, clipping is a longer procedure. An uncomplicated surgical clipping operation generally takes between three to five hours of operating room time. More complex cases can extend this duration significantly beyond five hours.
Variables Affecting Operating Room Time
The time ranges provided for coiling and clipping represent typical cases, but several factors cause the operating room time to fluctuate. The most critical determinant is whether the aneurysm has ruptured, which introduces immediate life-saving requirements. Ruptured aneurysms require more complex management due to the presence of blood in the brain and the need to manage bleeding. This heightened complexity prolongs the time spent in surgery for either procedure.
The physical characteristics of the aneurysm also influence the length of the operation. Larger aneurysms require more time, as do those with a complex or broad neck where the aneurysm meets the parent artery. For coiling, using supportive devices like stents or balloons to place coils into wide-necked aneurysms adds considerable time. Furthermore, an aneurysm located deep within the brain or in a challenging anatomical position increases the time needed for safe access and manipulation.
Immediate Post-Surgical Monitoring and Stay
Following the procedure, the patient is transferred to the Post-Anesthesia Care Unit (PACU) for close observation while waking up from general anesthesia. This phase typically lasts at least two hours. After the PACU, patients are moved to the Neuro-Intensive Care Unit (Neuro-ICU) for intense, continuous monitoring, which is mandatory for both procedures.
The duration of the ICU stay differs based on the surgical approach and the aneurysm’s status. For patients undergoing endovascular coiling for an unruptured aneurysm, the hospital stay is often short, sometimes only overnight or up to two days. Clipping for an unruptured case requires a longer stay, typically ranging from three to five days, for monitoring following the craniotomy. A ruptured aneurysm necessitates the longest hospital stay, often extending to two to three weeks or longer. This extended period is necessary for surveillance of potential complications like vasospasm, the dangerous narrowing of blood vessels that can lead to stroke.