Brain aneurysms are more common than many people realize. The American Stroke Association estimates that about 30,000 ruptured cerebral aneurysms occur each year in the United States. During brain aneurysm treatment, the goal is to stop blood from entering the weakened portion of the artery and prevent it from rupturing or bleeding again. Brain surgeons can choose from several techniques, including surgical clipping, which involves opening the skull and placing a small clip across the aneurysm, and endovascular treatment, which uses a catheter inside the blood vessels to place coils, stents, or a flow-diverting device.
The right procedure for you depends on the aneurysm's anatomy and your individual risk factors. Read on to learn more about how each procedure works, how a surgeon decides which procedure is best for you, and where to find the best brain surgeon in Los Angeles for precision accuracy.
What Happens Before Brain Aneurysm Surgery?
Before anyone decides how to treat an aneurysm, a neurosurgeon needs a detailed picture of it. This usually involves brain imaging such as CT angiography, magnetic resonance angiography, or cerebral angiography. These studies show where the aneurysm sits, how large it is, how it connects to the surrounding blood vessels, and whether there are additional aneurysms.
A cerebral angiogram can provide especially detailed information about the blood vessels. This is usually recommended when the anatomy needs to be mapped precisely before treatment. Imaging also helps determine:
- Whether the aneurysm has ruptured
- Its size and shape
- Its location
- The width of its neck
- The arteries branching from or near the aneurysm
- Your age and general health
- Your family history
- Previous aneurysm growth or changes on imaging
- Other factors that may affect surgical or endovascular risk
Modern Treatment Options for Brain Aneurysms
There are three main treatment options for brain aneurysms:
- Microsurgical Clipping: A small titanium clip at the base of the aneurysm to stop blood flow into it while keeping the surrounding artery open.
- Endovascular Coiling: A catheter delivers soft platinum coils into the aneurysm, encouraging a clot to form and blocking blood from entering the weakened area.
- Flow Diversion: A flow-diverting stent is placed inside the artery to redirect blood away from a large or complex aneurysm, allowing the aneurysm to gradually heal.
How is Microsurgical Clipping Performed for Brain Aneurysms?
During this procedure, a neurosurgeon begins by making an incision in the scalp and creating a temporary opening in the skull called a craniotomy. The surgeon then works carefully toward the aneurysm, often using natural spaces around the brain to reach the blood vessel while minimizing manipulation of normal brain tissue.
Once the aneurysm is found, the surgeon places a small metal clip across its neck. The clip blocks blood from entering the aneurysm while allowing blood to continue flowing through the normal artery. The clip remains in place permanently.
Before closing the incisions, the surgeon confirms that the aneurysm has been adequately treated and that blood continues to flow through the important arteries around it. Imaging may be performed during or after the procedure to confirm success. Surgical clipping is a type of brain aneurysm surgery that is performed under general anesthesia.
How is Endovascular Coiling and Flow Diversion for Brain Aneurysms Performed?
During a coiling procedure, a physician guides a thin catheter through an artery, often beginning at the wrist or groin, and advances it to the blood vessels supplying the brain. Tiny platinum coils are then placed inside the aneurysm. The coils reduce blood flow into the aneurysm and encourage clotting that seals it from the circulation.
Flow diversion works differently. Instead of filling the aneurysm itself, a specialized stent is placed in the parent artery. The device changes blood flow so that less blood enters the aneurysm, allowing the body to gradually seal it.
Which Surgery is Best for Brain Aneurysms?
There is no single aneurysm treatment that is best for every patient. Clipping and endovascular treatment solve the same basic problem, but they reach the aneurysm in very different ways:
| Treatment |
How It Works |
Potential Advantage |
Important Consideration |
| Surgical clipping |
A clip is placed across the aneurysm's neck through a craniotomy |
Can provide a durable, direct repair |
Requires open surgery and a longer recovery |
| Endovascular coiling |
A catheter delivers tiny coils into the aneurysm |
Less invasive and does not require opening the skull |
Some aneurysms may recur and require follow-up |
| Flow diversion |
A specialized stent redirects blood flow away from the aneurysm |
Useful for certain larger or complex aneurysms |
Not appropriate for every aneurysm and requires careful selection |
What Happens After Brain Aneurysm Surgery?
After brain aneurysm surgery, the first priority is protecting the brain and confirming that the aneurysm has been successfully secured. During this time, brain surgery patients are closely monitored for changes in neurological function, blood pressure, brain pressure, and other potential complications. Depending on the circumstances, additional imaging may be performed to confirm the result.
Recovery timelines vary, depending on whether the aneurysm was ruptured. Someone who has treatment for a small, unruptured aneurysm may leave the hospital relatively quickly and gradually return to normal activities.
A ruptured aneurysm is a different situation. The hemorrhage itself can injure the brain, and the purpose of surgery is to prevent another bleed while the medical team manages complications and supports the brain's recovery.
When Should You See a Brain Aneurysm Specialist?
A sudden, severe headache that becomes intense quickly, especially when accompanied by vomiting, loss of consciousness, weakness, confusion, vision changes or difficulty speaking, requires emergency medical attention. A ruptured aneurysm can cause a subarachnoid hemorrhage, and rapid treatment is critical.
If an aneurysm has been discovered incidentally on an MRI or CT scan, the situation is different. You may not need immediate treatment, but you should have the aneurysm evaluated by a specialist with specific expertise in cerebrovascular disease.
Where to Find the Best Brain Surgeon in Los Angeles for a Brain Aneurysm
Brain aneurysm treatment requires detailed knowledge of cerebrovascular anatomy, careful interpretation of imaging, and the ability to select an approach based on the individual aneurysm rather than a one-size-fits-all protocol.
Dr. Arnau Benet, MD, PhD, is a cerebrovascular neurosurgeon with extensive international training in complex brain and vascular conditions. Originally from Barcelona, Dr. Benet studied medicine at the University of Barcelona, where he taught neuroanatomy and conducted advanced neurosurgical research in a cadaver laboratory.
As an Assistant Professor of Neurosurgery at UCSF and an Adjunct Professor at Barrow Neurological Institute, patients across Southern California choose Dr. Benet for his cerebrovascular and skull-base expertise to treat aneurysms that require precise access to complicated vascular anatomy.
Ready to see the best brain surgeon in Los Angeles for expert neurosurgical care?
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