Clipping is still the most common surgical treatment for brain aneurysms. It is an effective, well researched surgical procedure with excellent results.

The patient is put under general anesthesia, and then prepped for surgery. The head is stabilized to make sure it does not move during the surgical procedure. Depending upon where the aneurysm is, an incision is typically made behind the hairline or on the back of the head. Next, a section of bone, or bone plate, is removed from the skull. The surgeon approaches the aneurysm in the cleft between the skull and the brain and not through brain tissue. Under a microscope, the aneurysm is then carefully separated from the normal blood vessels and brain.

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What is aneurysm clipping ?

The goal of surgical clipping is to isolate an aneurysm from the normal circulation without blocking off any small perforating arteries nearby. Under general anesthesia, an opening is made in the skull, called a craniotomy. The brain is gently retracted to locate the aneurysm. A small clip is placed across the base, or neck, of the aneurysm to block the normal blood flow from entering. The clip works like a tiny coil-spring clothespin, in which the blades of the clip remain tightly closed until pressure is applied to open the blades. Clips are made of titanium and remain on the artery permanently.

Aneurysms vary in their size and shape. Saccular aneurysms have a neck at their origin on the main artery and a dome that can expand and grow like a balloon. These are the easiest to place a clip across. Some aneurysms have a wide neck or are fusiform in shape having no defineable neck. These are more difficult to place a clip across. Since aneurysms have various neck configurations, clips are made in a variety of shapes, sizes, and lengths

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The surgical decision Surgery in india

The treatment decision for observation, surgical clipping or bypass, or endovascular coiling largely depends on the aneurysm’s size, location, and neck geometry. The less invasive nature of coiling is likely to be favored in patients who are older, are in poor health, have serious medical conditions, or have aneurysms in certain locations. In patients younger than 40 years of age, the difference in the safety between coiling versus clipping is small. Therefore, the better long-term protection from bleeding may give patients with clipped aneurysms an advantage in life expectancy.

Endovascular Coiling v. Surgical Clipping Surgery in india

Until recently, most studies on the surgical clipping and endovascular treatment of brain aneurysms were either small-scale studies or were retrospective studies that relied on analyzing historical case records. The only multi-center prospective randomized clinical trial – considered the gold-standard in study design – comparing surgical clipping and endovascular coiling of ruptured aneurysm is the International Subarachnoid Aneurysm Trial.

The study found that, in patients equally suited for both treatment options, endovascular coiling treatment produces substantially better patient outcomes than surgery in terms of survival free of disability at one year. The relative risk of death or significant disability at one year for patients treated with coils was 22.6 percent lower than in surgically-treated patients.

Treatment of Unruptured Aneurysms in India

Although no multi-center randomized clinical trial comparing endovascular coiling and surgical treatment of unruptured aneurysms has yet been conducted, retrospective analyses have found that endovascular coiling is associated with less risk of bad outcomes, shorter hospital stays and shorter recovery times compared with surgery.

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