Clipping and coiling

During my ct scan 3 months ago they found two small (2mm) aneurysms:

2 X 2 mm superiorly projected anterior communicating artery aneurysm
2 mm inferiorly projected LEFT posterior communicating artery aneurysm


I saw the neurosurgeon a couple days ago. It was a brief visit and he said he could do surgery and my aneurysms were in a good place for it. I came away thinking he meant coiling, which seems to be a pretty good remedy. They go in through the groin and almost no recovery time. A no brainer (pun intended!). So I was feeling pretty good.

Today I called to double check about insurance and I found out that this Dr does CLIPPING and was talking about CLIPPING. Not coiling!

Am I even a good candidate for coiling? Does the 2 X 2 mm mean wide neck, which means coiling is out?

Clipping looks like a very big deal!!

Thank you!!!

Go for the clip. I’ve had one for 18 years with no problems. I’ve heard coils can move and not be permanent…

Yes, clipping is very big deal. I had a craniotomy for clipping almost a year ago, and they clipped 5 aneurysms for me. Though my surgery went well, and I came out with no major issues, for which I am thankful, I would still describe my surgery as life changing. I now have insomnia, and sensitivity to sound, stimuli, etc. Before going into this type of surgery, I would make sure the benefits outweigh the risks. There are 3 options in regards to unruptured aneurysms: 1) watch and wait 2) coil or 3) clipping. Some aneurysms are small enough that neurosurgeons agree that it's reasonable to just watch them with periodic MRI's. Other aneurysms present more of a risk, especially if they show significant growth from year to year, which was my case (2 or my 3 knowns aneurysms had grown to 5mm and 6 mm). In those cases, the neurosurgeon may advise it is best to operate. Before my surgery, I sought information online in regards to the different treatments. I wanted to understand what I might be getting into. In my case, I HAD TO go the clipping route, because coiling was risky to my kidneys because of the die used. I understand the fear of living with unruptured aneurysms, and I know what it is like to recover for clipping. Recovery is not a bed of roses. Since your aneurysms are small, I wonder why your surgeon did not suggest the watch and wait approach as an option. I would try to talk to the doctor again and get more information before agreeing to this invasive surgery. Getting a second opinion might be another idea. Have you had an MRI? or Angiogram? With those tests, doctors are better able to see the accurate size and location of the aneurysms. Competent neurosurgeons usually have a patient do either or both of these tests before operating. It gives them a map with which to work. Please, do more homework before going into a clipping surgery.

Amy, isn't the recovery pretty hard and aren't there often issues? I've read quite a few scary bits about clipping. I'm 62 years old. On the pro side: I think my surgeon is really good (Dr Spetzler at Barrows in AZ) and he said mine were in a good place for surgery. And I was thinking....online we don't hear so many success stories because people are out living their lives. It's when we have the problems that we need support. But I have to say, clipping scares me to death right now. How was your recovery? After effects?

Bermudez, I have never heard of this! I am one of those people who starts to research, hits a bit of unexpected bad news and goes into a huge anxiety tailspin. I can handle anything buy serious health issues. So, I will start looking into this...or have a friend with medical background look into this! Thank you!!!!

Thank you both so much!

Nina, yes, you can bet I'm not jumping in to clipping. I think the issues are that I have 2 aneurysms, am 62 so earlier the better for surgery and one of the aneurysms is in a place where small sized aneurysms have more of a chance to bleed:

"Aneurysms at certain locations (such as the basilar artery and the posterior communicating artery) are more likely to bleed at a smaller size."


I still have not resolved quite a few questions. What does 'smaller size' mean? How much of a chance is there OVERALL that they will bleed? I hear 1%, which I think means 2% for me (2 aneurysms) but the surgeon said the risk goes up every year. And how much does the location risk add to the odds. I don't know. And that I have 2 means, per surgeon, that my veins aren't as strong as they should be....leading me to think that I have a good chance of more aneurysms, but the doc said no, it would be very rare to get another one after surgery.

Thank you so much for replying. This is so helpful. And I'm not even freaking out! Just learning. :)

I had a 5 mm and the dr. coiled it , 6 mo checkup showed it was still perfect ~ no need

to go back until 1 yr for MRI.

Please consider the coiling. I had clipping because the neck was large feeding off two arteries. It was very invasive surgery with taking out 7" of scull. Aneurysm was large but did not burst, thank GOD. I was 70 at that time and have had numerous Tia’s and 4 weeks ago a minor stroke. Research carefully.I understand they can go in the side of your body or groin area for coiling. Much easier recovery than clipping.

Every case is different. Sorry for your shock! Not fun to get unexpected news. The best thing you can do is get 2nd opinions from a clipper AND a coiler unless you find someone who does both (which is rare but my NYU doctor does both so I know a few exist). In Phoenix, Dr. Robert Spetzler is a world-renowned MASTER (he trained my surgeon) so he’d be a great one for you to see. Best of luck :slight_smile:

Sam, I am hoping to follow in your footprints!

Pat, believe me, if I am a candidate for coiling, that is the way I'll go (unless the endovascular procedure looks even better). I do not think I could go for clipping under the circumstances (2 2mm aneurysms). I'd wait and see if they grew. And do a LOT of research.

If I was a candidate for coiling, wouldn't you think the surgeon would recommend that, even if all he does is clipping? Seems like the first choice would always be the most noninvasive.

I am glad you came through surgery without a rupture! But sorry to hear that all is not back to normal, which is what I wish for all of us.

Dear July yes, depending on your age, your physical conditions in general, the size and location of your aneurysm you might have many (or just one) options of treatment. In the last 4 years there have been new developments and better treatments. The options are clipping, coiling, or other endovascular treatments (pipeline, glues, stents). Depending on the specialist that you talk to they are going to sell their services and sometimes that one might not be in your best interest, and may be there is another option that is better. In any case, from my own experience it is better that you do the best test there is to look at the size, form and location of your aneurism, that is Cerebral angiogram, because in many instances a Computerized tomography (CT) might miss the existence of another (or even more than one) aneurism that requires treatment sooner than the one that you just found. That was my case! I had two! and the one that required treatment was not seen with the first test. Please check this source too:

http://www.mayoclinic.org/diseases-conditions/brain-aneurysm/basics/tests-diagnosis/con-20028457

http://www.neurosurgicalatlas.com/patient-resource-center/category/brain-aneurysms-arteriovenous-malformations.

Please read a lot, talk to some other specialist and take an informed decision!

God Luck!

And also... I know exactly how you are feeling, but I think that it is better that you discovered them and will treat them and not that you learned because a ruptured one with some bad consequences.... focus on the positive side!

Yours are small, so you have more time to consult and to do research, and find the best option for your case.

Given the size of yours the wait and see is an option, but for me it was not. The stress of knowing that I had a time bomb in my head was too much. The other thing is that at the time I was in the middle of divorce so I would loose my insurance, plus that the older we get or the larger the aneurysm get the complications increases as well.

Good luck!!!

Jennifer, Dr. Robert Spetzler is the very person I did see! His reputation is excellent. But he does only clipping and I wonder if I could get coiling wouldn't he have recommended that as an option? I am waiting a call back from one of his residents, but that might take a while. I was pretty OK with the coiling and the news that he was planning clipping brought be down with a crash.

Bermadez, I have been thinking about asking for an angiogram and was a bit surprised that the dr didn't order one. They are pretty invasive, though and carry some risk from what I have read.

Thank you for the links, everyone!

I'm in good physical condition, although all this worry will probably be the death of me.


July;

A picture is worth a thousand words, and a 3D printed replica of your vascular system is worth a hundred time s that. If you have the ability I suggest you contact Dr. Woo at the Stony Brook University Hospital Long Island New York. He has entered into ground breaking technology where he develops a 3D printed version of your vascular system, places/suspends it inside a clear plastic human replica, and than decides the best method of corrective action. It will also give you a clear picture of the procedure they have to do. Good luck to you

July, I failed to mention that no MRI’s after clipping because of titanium clip. Magnets could cause death I have been told.

July, I had my aneurysm clipped in 2011 when I was 64. I was in good health although I do have high blood pressure controlled by medication. initial surgery was a success but 5 weeks later I had developed a staph infection at incision site. They cleaned out the wound, threw out my infected bone flap, one week in hospital, and 6 weeks of home IV. Six months later I had a third surgery to insert a manmade skull piece. It was a long journey but I am here to tell you about it. Other than scars and some numbness I feel fine. My surgeon was skilled in both clipping and coiling…he studied the size, type and location of aneurysm along with my health in determining which was the best procedure.
I have been assured that the clip is titanium and presents no problems for future MRIs.
I also had open heart surgery in 2013 for an ascending aortic aneurysm… Since my mother died of a ruptured brain aneurysm, I truly believe all my problems were genetic.
You must have a surgeon with whom you have complete trust and confidence.

Pat Case, not true. Recent clips are non-magnetic. Mine is a Yasargil FE. There is only one report of a fatality and that was because erroneous information was given to the radiologist.

Maybe your doc doesnt do coiling
I 'd check around

Lily, he doesn't. But I would think that he would bring up that option if it were an option??

"You must have a surgeon with whom you have complete trust and confidence."

Arleen, I totally agree. I thought I had one but I'm not quite there yet I find. I am amazed at what you have had to go through!! I really started out thinking these things were no huge deal in 2000+% of the cases. Now it seems like that was a pipe dream. Congratulation on your courage and ability to make it through this.

James, thank you! I will check Dr Woo out. This is a possibility. I could make it happen.

I need to find out the chance of rupture in two 2mm and compare that to coiling. I am in no mood to consider clipping.

July
Don’t ever agree to anything you don’t understand! You cannot be forced to a procedure you don’t want…thats YOUR CHOICE NOT HIS. If you are a candidate for coiling and you feel this is the right choice go for it!
I have seen that sometimes they will recommend what is easier for them to finish in one scoop when dealing with more than one aneurysm and don’t deal with it later.
Ask for an appointment to re affirm what is the best procedure with pros/cons and then male your decision. Check online how compentent he is to trust him with the procedure(check his profile).
I wish you the best!

Hi July, The most constructive post that I have seen is by Nina!!!

I attach a web sit for you to look at regarding un-ruptured aneurysms, study it and look at the %s

http://www.nejm.org/doi/full/10.1056/NEJM199812103392401

Some background, I have 5, 2 have been coiled and stented by endovascular treatment, 1 was in the basilar region and the other was in the ophthalmic region, they were +- 6mm.

The remaining 3 are 2 x Right side MCA and 1 x left side MCA which can only be fixed by open surgery, they range from 6mm to 12 mm and the big one is very complicated, I decided no ways am I having open surgery, so they are monitored every 12 months by scans and angiograms, that is my call and I live with it!

If I was in your situation, I would be asking if they could be treated by Endovascular means, ie: coiling, as it is less invasive!

Please do not be afraid of an angiogram scan, it is a breeze and is over so quickly!

Do your self a favour, ask the question above to the neurosurgeon, can they be treated by coiling?

After you read the link above, 2mm in the grand scale of things, compared to the risk is minimal, so get wise, get a second opinion from an endovascular specialist and then make a decision.

Most importantly, remember this is not a train smash, but just one of life's challenges, so chill!

Please feel free to contact me at any time for input!

Kind Regards

Martinc