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Aneurysm Simple
Simple Aneurysm Clipping is a neurosurgical procedure that places a small metal clip across the neck of a cerebral aneurysm — permanently securing it and preventing rupture or re-bleeding, protecting the patient from the devastating consequences of subarachnoid haemorrhage.
Overview
Simple Aneurysm Clipping is performed for straightforward, accessible, saccular cerebral aneurysms that are amenable to direct microsurgical clipping through a craniotomy, permanently excluding the aneurysm from the circulation while preserving the parent artery and all surrounding neural and vascular structures. The procedure uses high-powered intraoperative microscopy, neuronavigation, and intraoperative fluorescence angiography to confirm complete aneurysm obliteration and normal blood flow in the parent vessel before closure. For suitable aneurysms, surgical clipping provides the most durable long-term protection against rupture and eliminates the need for repeated follow-up imaging required after coiling.
Types of Cerebral Aneurysm Treatment
The treatment of cerebral aneurysms encompasses surgical clipping and endovascular coiling approaches, with the choice depending on aneurysm morphology, location, patient age, and available expertise.
- Surgical Clipping (direct titanium clip placed across the aneurysm neck through craniotomy)
- Endovascular Coiling (platinum coils delivered through a catheter to fill the aneurysm sac)
- Flow Diverter Implantation (pipeline stent redirecting blood flow away from the aneurysm)
- Surgical Clip Wrapping (for fusiform or blister aneurysms not amenable to neck clipping)
- Combined Surgical and Endovascular Approach (for complex aneurysms requiring hybrid treatment)
Risk Factors for Cerebral Aneurysm
Cerebral aneurysms often develop silently over years before either presenting symptomatically or being discovered incidentally on brain imaging. Understanding these risk factors guides screening recommendations.
- Hypertension — the most important modifiable risk factor for aneurysm growth and rupture
- Smoking significantly increasing the risk of aneurysm formation, growth, and rupture
- Family history of intracranial aneurysm or subarachnoid haemorrhage in first-degree relatives
- Polycystic kidney disease associated with significantly higher intracranial aneurysm prevalence
- Connective tissue disorders including Marfan syndrome and Ehlers-Danlos syndrome
- Female sex — women have a higher risk of aneurysm rupture than men, particularly after menopause
Cerebral Aneurysm Symptoms
Unruptured aneurysms may be entirely asymptomatic or produce symptoms from their mass effect. Ruptured aneurysms present dramatically. Recognising both presentations saves lives.
- Thunderclap headache — the sudden, excruciating worst headache of the patient's life from rupture
- Nausea, vomiting, and photophobia following subarachnoid haemorrhage
- Loss of consciousness at ictus in up to 40% of subarachnoid haemorrhage cases
- Diplopia (double vision) or ptosis from a posterior communicating artery aneurysm pressing on the oculomotor nerve
- Visual field defect from a large ophthalmic artery or carotid aneurysm
- Focal neurological deficit from direct neural compression by a large unruptured aneurysm
- Seizures in patients with perianeurysmal haematoma following rupture
- Incidental finding on MRI or CT performed for an unrelated reason
Key Benefits
Discover the advantages of choosing our aneurysm simple services.
Permanent, definitive closure of the aneurysm with no need for repeat treatment or surveillance imaging
Single definitive procedure that eliminates the aneurysm from the circulation permanently
Stops or prevents subarachnoid haemorrhage and its devastating neurological consequences
Intraoperative confirmation of complete obliteration provides immediate reassurance
Performed by a dedicated neurovascular surgical team with specialist aneurysm surgery expertise
Clinical Features
The technology, techniques and clinical approach behind our aneurysm simple.
Intraoperative neuromonitoring protects neural function throughout the entire clipping procedure
Operating microscope provides powerful magnification for sub-millimetre precision clip placement
Intraoperative ICG fluorescence angiography confirms complete aneurysm obliteration immediately
Titanium clip is permanent — provides lifelong protection against aneurysm rupture or re-bleed
Neuronavigation guidance minimises brain retraction during approach to the aneurysm
Preparation Instructions
- Complete a detailed CT angiogram and digital subtraction angiography (DSA) to characterise the aneurysm anatomy precisely
- Provide blood tests including CBC, coagulation, blood group and crossmatch, and kidney function
- Optimise blood pressure control strictly before and during surgery
- Stop anticoagulants and antiplatelet medications under neurovascular supervision
- Fast for 8 to 10 hours before the procedure
- Arrange home support for 3 to 6 weeks post-discharge
- Quit smoking immediately and permanently — smoking is the single most controllable risk factor for aneurysm growth
- Attend pre-operative neuroanaesthesia and neurosurgical consent consultation to discuss the surgical approach and expected outcomes
The Procedure
Step-by-step guide to what you can expect during your aneurysm simple procedure.
Neurovascular Team Assessment
Your neurovascular specialist reviews your CT angiogram and digital subtraction angiogram in detail to confirm the aneurysm's precise location, neck morphology, size, dome-to-neck ratio, and relationship to parent and branching arteries — determining that surgical clipping is the most durable and safest treatment option for your specific aneurysm.
General Anaesthesia and Neurophysiological Monitoring
General anaesthesia is induced with continuous intraoperative neuromonitoring including motor evoked potentials and somatosensory evoked potentials. A lumbar drain may be placed to gently reduce intracranial volume and improve brain relaxation during surgery, facilitating safe access to the aneurysm without excessive brain retraction.
Precise Craniotomy Positioning and Opening
You are positioned in the appropriate head-fixed position based on the aneurysm location and a precisely planned craniotomy is performed. The dura is opened carefully and the brain is inspected. Neuronavigation guidance may be used to direct the corridor to the aneurysm with the least disruption of normal brain tissue.
Sylvian Fissure Dissection and Aneurysm Exposure
Working under the operating microscope with powerful magnification and illumination, your neurosurgeon dissects the sylvian fissure or basal cisterns to gradually expose the aneurysm and all surrounding vessels. All arteries feeding and draining the aneurysm are carefully identified and preserved before any clip is applied.
Precise Clip Application Across the Aneurysm Neck
A titanium aneurysm clip is selected and positioned precisely across the aneurysm neck — permanently excluding the aneurysm from the circulation while ensuring complete patency of the parent artery and all branch vessels. The clip position is assessed visually and with intraoperative indocyanine green fluorescence angiography.
Fluorescence Confirmation and Closure
Indocyanine green fluorescence angiography or intraoperative Doppler confirms complete aneurysm obliteration and unobstructed blood flow in all adjacent vessels before the dura and skull are closed. A post-operative CT angiogram in the recovery room provides final confirmation of the successful clip result.
What to Expect
Aneurysm Clipping is performed under general anaesthesia and takes 2.5 to 4 hours. A temporal or frontal craniotomy provides access to the sylvian fissure or basal cisterns where the aneurysm is located, and the neurosurgeon carefully dissects the aneurysm under the operating microscope before placing a titanium clip precisely across its neck to permanently exclude it from the circulation. Intraoperative fluorescence angiography confirms complete clipping without compromise of adjacent vessels. Recovery in the neurosurgical ICU takes 24 to 48 hours.
Recovery
After Aneurysm Clipping, take all prescribed medications including antihypertensives and anti-epileptic drugs without interruption. Attend all follow-up CT angiogram appointments at 6 weeks, 1 year, and 5 years to confirm permanent aneurysm exclusion. Control blood pressure rigorously and stop smoking permanently — these are the two most important steps in protecting against new aneurysm formation. Contact your neurosurgeon immediately for sudden severe headache, new neurological symptoms, fever, or wound concerns.
Frequently Asked Questions
Common questions about aneurysm simple.
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