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Brain aneurysm repair - discharge

Definition

You had a brain aneurysm. An aneurysm is a weak area in the wall of an artery that bulges or balloons out. Once it reaches a certain size, it has a high chance of bursting. It can leak blood along the surface of the brain. This is called a subarachnoid hemorrhage. Sometimes bleeding can occur inside the brain. This is called intracerebral bleeding.

You had surgery to prevent the aneurysm from bleeding or bleeding again. After you go home, follow your surgeon's instructions on how to care for yourself. Use the information below as a reminder.

When You're in the Hospital

You likely had one of two types of surgery:

• Open craniotomy, during which the surgeon makes an opening in your skull to place a clip on the neck of the aneurysm.

• Endovascular repair, during which the surgeon, neurologist, or radiologist treats the aneurysm by going through blood vessels rather than opening the skull.

What to Expect at Home

If you had bleeding from your aneurysm before, during, or after surgery you might have some short- or long-term problems. These may be mild or severe. For many people, these problems get better over time.

In this situation, you may:

• Feel sad, angry, or very nervous. This is normal.

• Have had a seizure and will take medicine to prevent another one.

• Have headaches that may continue for a while. This is common.

What to expect after craniotomy and placement of an aneurysm clip:

• It will take 3 to 6 weeks to fully recover. If you had bleeding from your aneurysm this may take longer. You may feel tired for up to 12 or more weeks.

• If you had a stroke or brain injury from the bleeding, you may have permanent problems such as trouble with speech or thinking, muscle weakness, or numbness.

• Problems with your memory are common, but these may improve.

• You may feel dizzy or confused, or your speech may not be normal after the surgery. If you did not have any bleeding, these problems should get better.

What to expect after endovascular repair:

• You may have pain in your groin area.

• You may have some bruising around and below the groin incision.

You may be able to start daily activities, such as driving a car, within 1 or 2 weeks if you did not have any bleeding. Ask your surgeon which daily activities are safe for you to do.

Self-care

Make plans to have help at home while you recover.

Follow a healthy lifestyle, such as:

• If you have high blood pressure, keep it under control. Be sure to take the medicines your health care provider prescribed for you.

• Do not smoke.

• Ask your surgeon if it is OK for you to drink alcohol.

• Ask your surgeon when it is OK to start sexual activity.

Take your seizure medicine if any was prescribed for you. You may be referred to a speech, physical, or occupational therapist to help you recover from any brain damage.

If your surgeon had to put a catheter in through your groin (endovascular surgery), it is OK to walk short distances on a flat surface. Limit going up and down stairs to around 2 times a day for 2 to 3 days. Do not do yard work, drive, or play sports until your surgeon says it is OK to do so.

Your surgeon will tell you when your dressing should be changed. Do not take a bath or swim for 1 week.

If you have a small amount of bleeding from the incision, lie down and put pressure on it for 30 minutes.

Be sure you understand any instructions about taking medicines such as blood thinners (anticoagulants), aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.

Follow-up

Make sure to follow-up with your surgeon as directed, usually within 2 weeks of being discharged from the hospital.

Ask your surgeon if you need long-term follow-up and tests, including CT scans, MRIs, or angiograms of your head.

If you had a cerebral spinal fluid (CSF) shunt placed, you will need regular follow-ups to make sure it functions well.

When to Call the Doctor

Contact your surgeon if you have:

• A severe headache or a headache that gets worse and you feel dizzy

• A stiff neck

• Nausea and vomiting

• Eye pain

• Problems with your eyesight (from blindness to peripheral vision problems to double vision)

• Speech problems

• Problems thinking or understanding

• Problems noticing things around you

• Changes in your behavior

• Feel weak or lose consciousness

• Loss of balance or coordination or loss of muscle use

• Weakness or numbness of an arm, leg, or your face

Also, contact your surgeon if you have:

• Bleeding at the incision site that does not go away after you apply pressure

• An arm or leg that changes color, becomes cool to touch, or becomes numb

• Redness, pain, or yellow or green discharge in or around the incision site

• A fever higher than 101°F (38.3°C) or chills

References

Backes D, Rinkel GJ, van der Schaaf IC, et al. Recovery to preinterventional functioning, return-to-work, and life satisfaction after treatment of unruptured aneurysms. Stroke. 2015;46(6):1607-1612. PMID: 25922514 pubmed.ncbi.nlm.nih.gov/25922514/.

Bershad EM, Suarez JI. Aneurysmal subarachnoid hemorrhage. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 29.

Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke. 2023;54(7):e314-e370. PMID: 37212182 pubmed.ncbi.nlm.nih.gov/37212182/.

Endovascular Today website. Leacy RD, Yaniv G, Nael K. Cerebral aneurysm follow-up: How standards have changed and why. February 2019. evtoday.com/articles/2019-feb/cerebral-aneurysm-follow-up-how-standards-have-changed-and-why. Accessed July 22, 2024.

Szeder V, Tateshima S, Jahan R, Saver JL, Duckwiler GR. Intracranial aneurysms and subarachnoid hemorrhage. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 67.

Review Date: 7/15/2024

Reviewed By: Luc Jasmin, MD, Ph.D., FRCS (C), FACS, Department of Neuroscience, Guam Regional Medical City, Guam; Department of Surgery, Johnson City Medical Center, TN; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.