Understanding : Treatment Options

Frequently Asked Questions of Aneurysm Patients

How long should I expect to be hospitalized?

  • The length of hospitalization is significantly different for patients with ruptured (subarachnoid hemorrhage or (bleeding) versus unruptured aneurysms.  Patients with unruptured aneurysms typically have a shorter hospital stay of approximately 2 – 3 days. The length of hospitalization of patients who have suffered subarachnoid hemorrhage is variable and is dependent on the condition of the patient on admission and the treatment of concomitant issues such as cerebral vasospasmVasospasm
    Generally, from four to fourteen days after an aneurysm ruptures, the blood vessels at the base of the brain may develop spasm or narrowing. If severe, this can result in stroke.
    , hydrocephalusHydrocephalus
    A generic term that describes too much fluid building up within the spaces inside the brain (also known as ventricles). This may occur after aneurysm rupture or bleeding from an AVM and may be life-threatening. Emergency treatment with placement of a drainage tube to relieve the pressure may be required (see below - ventriculostomy).
    , and ventilatory issues. In patients with severe subarachnoid hemorrhage, hospitalization may be up to 3 – 4 weeks.

What can I bring to the hospital?

  • Bring a list of all medications, contact numbers of personal physicians, and your health care proxy.

Do my relatives have to be checked for the presence of aneurysms?

  • Cerebral aneurysms are generally not a familial or genetic disease and in most cases it is not recommend that family members are screened. In cases where there is a family history of aneurysms(two or more family members), it is recommended that all family members should consult with their physicians to receive non-invasive screenings, such as MRA or CTA.

Can I have visitors?

  • Absolutely! Visitation hours are dependent on hospital rules and on the level of care.

When can I get out of bed?

  • Patients with unruptured aneurysms get out of bed on day one after treatment. Quick mobilization and early activity are critical parts of recovery.

When will the incision be healed?

  • Incisions after aneurysm surgery heal over a period of approximately 6 weeks. If you have stitches or staples, you will return to the surgeon’s office in a week to 10 days for removal. Some surgeons use dissolvable suture material, and in such circumstances, the stitches will dissolve over a period of weeks. After endovascular coiling, there is quick healing of the puncture site in the groin. If there is any pain or swelling in this area, contact your doctor immediately.

Will I get prescriptions for pain medications upon discharge?

  • Yes, you will be provided with a clear set of instructions and prescriptions at the time of discharge.

How long am I going to be on medications?

  • Most aneurysms patients are off all pain medications within 1 – 3 weeks. Other medications, for instance, anti-hypertensive drugs, will be modulated by your internist. After endovascular coiling, selected patients may be on “blood-thinners”, such as Plavix or aspirin.

When can I shower/wash my hair?

  • After all sutures have been removed.

When can I be active again?

  • Early activity is the cornerstone of recovery. Most hospitals advocate, in conjunction with assistance from the physical therapy staff, early mobilization in the hospital and a program of home rehabilitation and physical therapy for the post-operative period. Every patient is different; the return to full activity after an aneurysm operation or aneurysm coiling is dependent on the condition of the patient prior to the treatment and immediately after treatment. Patients with unruptured aneurysms typically return to full activity over a period of 2 – 6 weeks, with fatigue being the major complaint.

What can I do to have the most successful recovery?

  • Follow all post-operative instructions regarding medications and post-operative therapy. Call your doctor immediately if there are any issues. Have a positive outlook!

Could I have known about this aneurysm before the hemorrhage?

  • In most situations, no. If there is a strong family history (two or more first degree relatives with a known cerebral aneurysm), it is possible to detect aneurysms in patients with non-invasive means prior to a rupture. Most aneurysms are asymptomatic.

Can I develop another aneurysm?

  • If you are a heavy smoker and continue smoking, it is very possible. If you have polycystic kidney disease, fibromuscular dysplasia, or any other type of elastic tissue disorder, you may warrant screening throughout your lifetime. Otherwise, it is extremely unlikely you would develop another aneurysm. Patients who are quite young (under 40) may be candidates for follow-up imaging later in life. Please discuss with your physician.

Is there a chance I can lose my eyesight?

  • It is extremely unlikely your eyesight will be affected, unless your aneurysm is in the location of the optic nerve or one near one of the cranial nerves such as posterior communicating artery. In such cases, visual disturbance may be temporary. Your physician will review all details pertinent to your situation.

How is the modality of treatment (clipping versus coiling) decided?

  • The decision regarding the modality of treatment is dependent on many factors, including the age and condition of the patient, the size of the aneurysm, the shape of the aneurysm, and the location of the aneurysm. In many cerebrovascular centers, imaging (MRIMRI
    Short for magnetic resonance imaging. This is a special radiologic test that allows for excellent imaging of the brain. Paradoxically, MRI does not show up fresh blood as well as CT, so if bleeding from an aneurysm is suspected, CT is a better test.
    /MRA, CTA and/or angiography)is reviewed by a multidisciplinary team including neurologists, neurosurgeons and interventional neuroradiologists. They will review the films and then decide on the appropriate treatment modality, specifically for each patient and with each patient.

Can the coils move or shift?

  • You should follow up with your doctor to monitor the coil mass with follow up MRA and angiography. In rare circumstances, an aneurysm can partially open, requiring further intervention.

Can I have an MRIMRI
Short for magnetic resonance imaging. This is a special radiologic test that allows for excellent imaging of the brain. Paradoxically, MRI does not show up fresh blood as well as CT, so if bleeding from an aneurysm is suspected, CT is a better test.
after clipping or coiling?

  • Yes, all titanium and platinum coils are MRI compatible. Titanium aneurysm clips are MRI compatible. Certain types of intracranial aneurysm clips (e.g., those made from martensitic stainless steels such as 17-7PH or 405 stainless steel) are an absolute contraindication to the use of MR procedures because excessive, magnetically induced forces can displace these clips and cause serious injury or death. By comparison, aneurysm clips classified as nonferromagnetic or weakly ferromagnetic (e.g., those made from Phynox, Elgiloy, austentitic stainless steels, titanium alloy, or commercially pure titanium) are safe for patients undergoing MR procedures (for additional information on performing MR procedures in patients with aneurysm clips go to www.MRIsafety.com) Make sure to check with your neurosurgeon, prior to MRI, if you have had surgery for a brain aneurysm (to confirm clip type). If you had clipping prior to the use of titanium, you should check with your neurosurgeon before MRI.

How soon can I drive?

  • This frequently asked question has no specific answer and varies from patient to patient. Patients with unruptured aneurysms are usually instructed to wait about 10 days – 2 weeks after uncomplicated surgery before driving. Patients who have had unruptured aneurysms treated with endovascular coiling typically can drive sooner. Patients who have suffered subarachnoid hemorrhage may return to driving after clearance from both their neurosurgeon and neurologist.

When can I be physically and sexually active again?

  • A physical therapy program is tailored for each individual patient. Moderate activity after discharge is encouraged. Your doctors will advise you on the level of activity and how quickly you can increase the amount of exercise and sexual activity.

Can sexual activity lead to a new subarachnoid hemorrhage after my aneurysm has been completely coiled or clipped?

  • No.

How soon can I return to work?

  • This is specific for each patient, their pre-treatment and post-treatment condition, and, of course, the demands of their job. Consult with your doctor.

Are children at risk for aneurysms?

  • Aneurysms are extremely rare in children. The average age for aneurysmal sub-arachnoid hemorrhage is approximately 55 years of age.

If an aneurysm has been discovered, for how long has it typically been present?

  • That is unknown. Aneurysms may slowly enlarge over time, yet the rate of growth is not completely understood. Some aneurysms, typically smaller aneurysms, may remain quiescent for decades.

How long does the coiling procedure take?

  • Approximately 1½ – 3 hours.

How long does clipping surgery take?

  • Approximately 3 – 4 hours.

Is general anesthesia used for surgery and coiling?

  • General endotracheal anesthesia is always used for surgical procedures and most often with coiling procedures. Monitored Anesthesia Care (MAC) is a specific anesthesia service in which an anesthesiologist has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure.
    Monitored Anesthesia Care often includes the administration of doses of medications for which the loss of normal protective reflexes or loss of consciousness is likely.

    Monitored Anesthesia Care refers to those clinical situations in which the patient remains able to protect the airway for the most of the procedure. If, for an extended period of time, the patient is rendered unconscious and/or loses normal protective reflexes, then anesthesia care shall be considered a general anesthetic. An attending anesthesiologist who is experienced in neuro-anesthesia is present at all times.

How long do I need to be on anti-convulsant medications (Dilantin, Keppra etc.) after surgery, or endovascular coiling?

  • Most patients who have suffered a SAH are weaned off these medications in a few months. Very few patients need to be on these medications chronically. Frequently, a neurologist helps in the modulation of the dosages during the weaning process.

Will an Intensive Care Unit (ICU) stay be necessary?

  • All treated aneurysm patients (endovascular coiling or microsurgical clipping) are monitored in the Intensive Care Unit in the immediate post-treatment period. The length of stay is dependent on whether or not the patient has had a subarachnoid hemorrhage and additionally in the presence of other medical and neurosurgical issues. Uncomplicated, unruptured aneurysms are usually in the ICU for 1 – 3 days after treatment.

Can I dye my hair after surgery?

  • Yes. After surgery, it is suggested you wait two months or longer depending on the healing of the incision.

Will the coils or clips set off a metal detector at an airport?

  • No.

Can I fly?

  • Yes. Patients diagnosed with an aneurysm can fly. After surgery, patients should consult with their doctor at their follow up appointment.

Do I need a long-term follow up after my treatment and discharge form the hospital?

  • This depends on your personal experience including medical and family history. After coiling, imaging follow-up (MRA, angiography) is necessary to confirm persistent occlusion 5 – 10 years after treatment. Sometimes, immediate post operative angiographic follow up is performed after microsurgical clipping.Sometimes long-term follow up is recommended.

A blood relative of mine has had an aneurysmal bleed. Does this increase my chance of having a subarachnoid hemorrhage?

  • It may. A positive family history of aneurysms or subarachnoid hemorrhage increases the statistical risk associated with unruptured cerebral aneurysms.