Clipping two "little" aneurysms

Continuing the discussion from New member trying to navigate this new reality:

Hi there Erin!

Your posts and questions have struck me because there are some similarities between us.
I too had 2 aneurysms, a tiny one and another that was also about 4mm. The larger one was an odd shape (a real ugly spud!) and therefore of greater concern- both my surgeons said the irregularly shaped ones are more likely to rupture than saccular aneurysms, even if they’re relatively “small”.
Both my surgeons recommended craniotomy and clipping and I’m glad they did. I consulted with two surgeons, not because I wanted a 2nd opinion, but because the first got sick and was unable to operate. I then went through the whole consulting process again with surgeon number 2.
What comforted me was that they agreed with each other- the clipping was likely to be a more permanent solution than coiling. As I was “young” (49) they said the clips will last “for life” and are MRI compatible. As it turned out, for me, craniotomy/clipping was probably the safer option. As others have said, your surgeon will advise what’s best for you, your particular aneurysms, and recovery.

I’ve had many CT angiograms and thankfully no issues with contrast dye, however, after I’d had several, my surgeon recommended that annual follow-up/monitoring scans are alternated with MRIs because of the amount of radiation in CT angios. My last check-up was via an MRI. Perhaps it’s an option for you?
(I’m lucky to have received my last MRI paid for by the government health service, but I know they can be really expensive).

I also had a femoral approach angiogram to get fancy pictures of the ugly spud aneurysm from all angles. For this one, they made a small cut in my groin and fed a catheter through the femoral artery and then guided it all the way up to the artery where they needed the pictures. In my case, the Internal Carotid Artery. I imagine it’s like driving a car through a narrow tunnel. I find it confusing that both the contrast dye version through my arm (awake, no sedative) and the femoral artery approach version with the tube through my groin (under general anaesthetic) have both been referred to as CT Angios.

I found out about my aneurysms in Feb 2018. I ignored it, didn’t see a surgeon until late 2019 and then was booked for surgery in April 2020. The surgery was delayed over and over because of Covid (it was cancelled during lockdowns we had) and then there was the first surgeon’s illness. By mid-2020, I was having terrible headaches, could see my right eye drooping, had a weird, scary sort of pulling behind my eye and if I walked up a hill, I could feel a strange rushing in my head. When the neurosurgeon finally operated he said he could see that the rupture was imminent with blood swirling. Because of its odd shape, he had to lift it to clip it from a different angle, and careful as he was, it still ruptured. He put a clamp on it for a few minutes, there was very little blood loss and then he continued with the clipping. I consider the clipping process a win!!
The other reason I’m glad clipping was recommended as opposed to coiling is something that probably applies to very few others. Apparently my blood vessels are unusually narrow and tear easily. During a post-clipping cerebral Angiogram (the catheter via the femoral artery), which was done to check the placement of the clips, the catheter punctured my carotid artery in my neck (an artery dissection). The vascular surgeon that was called to assist the neurosurgeon said my blood vessels are unusually “friable”. The internal wall comes apart easily.
Who knew?!
The tear in the internal wall of the artery is still there and I get regular checks for it too and take a low dose blood thinner to prevent clots. Its sometimes referred to as a pseudo-aneurysm, and the only way to fix it is via placing a stent using the same catheter method that caused it. So, it’s better to leave it than risk more damage or a stroke.
My very long winded point (sorry!) is that without knowing it, coiling which uses a catheter through the artery, would not have been suitable for me.
Recovery and after effects of clipping : It’s 19 months later. How do I look? I have a small dent in my forehead but my hair easily covers it. I can’t see the scar. When it was first done it looked like I had a neat zipper on my forehead but once the stitches were removed, it seemed to fade quickly. Where the bone plate was removed there’s a very slight ridge under my hair. It’s not visible.
How did my head feel straight afterwards?
Weird. Lots of weird sensations and unexpected things such as my skull making noises in the first few days. It’s a whole healing process but whilst there is some discomfort, I didn’t find any of the pain as intense as the headaches that I had pre-surgery. Pretty sure I would be dead or severely damaged had it ruptured anywhere else but on the operating table. Definitely glad I had it done!!

Hi Nat! Thanks so much for sharing your story :blush: there definitely are some similarities in our situations. While you called your larger aneurysm a spud, my doctor likened mine to a mushroom :mushroom: haha. Although on the smaller side, the irregular shape is what is concerning. The risk of rupture during the procedure is the main reason I am leaning towards the clipping vs coiling. And he did say it was more of a permanent fix.

The angiogram was super uncomfortable but maybe with some sedation it wouldn’t be so bad. My angiogram was also through the femoral artery, he tried through my wrist first but found the arteries closer to my heart are arranged backwards, something he called a “normal variance”. Weird what they find once they get in there.

Anyway I will keep you all posted on which way we go once I talk to my doc next week!

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I hope once you’ve spoken to your doc/docs that the decision feels clear and obvious. Will look out for your updates.
Thinking of you!