Brain Aneurysm

Fan xiu lan Lu qiao xian

Cerebral or Brain Aneurysm

A cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

Brain Aneurysm
1-2% of the population have unruptured aneurysms Any aneurysm can rupture, although statistically larger (>1cm 4%) aneurysms are more likely to do so. Women>Men, incidence increases linearly with age 10-15% of patients presenting with SAH have multiple aneurysms

Anatomy of Brain

Located inside the skull, the brain has many specialized groups of cells. The 4 ventricles inside the brain make cerebrospinal fluid (CSF). The brain receives blood from 2 main groups of arteries(Int. & Ext. carotid arteries) It is connected to the spinal cord. The brain and spinal cord are called the bodys central nervous system.

30-35%

30-35% 20%

5%

Types of Brain Aneurysm

Saccular Aneurysm
The most common type of aneurysm and account for 80% to 90% of all intracranial aneurysms The most common cause of nontraumatic subarachnoid hemorrhage (SAH) Circle of vessels around the base of the brain where most aneurysms are found

Types of Brain Aneurysm

Fusiform Aneurysm

An irregular shaped widening of a cerebral vessel that does not have a discrete neck or pouch of the side of a vessel. less common type of aneurysm. It looks like an outpouching of an arterial wall on both sides of the artery or like a blood vessel that is expanded in all directions. The fusiform aneurysm does not have a stem and it seldom ruptures.

Types Of Brain Aneurysm

Pre-operative Considerations

Two diathermy machine Two suction machine Positioning devices are ready Microscope and Micro instruments Bipolar bayonet Legend and tools Theatre set up To standby blood product CT angiography images Haemostatic agent: Floseal and surgicel

Positioning Devices

Mayfield Clamp Device

attachments

Positioning Devices
Sugita Head Frame

Pre-operative Preparation

Aneurysm clips and appliers (minimum 2) of the surgeons choice must be available

Pre-operative Preparation

The environment should be as quiet as possible, with minimal physiological and psychological stress. Elevate the head of the trolley 30 to 45 degrees Limit visitors to immediate family and significant others. Discourage and control any measure that initiates Valsalvas maneuver, such as coughing, straining at stool, pushing up in bed with the elbows, turning with the mouth closed. Educate patient about these. Maintain seizure precautions ( have suction equipment and oropharyngeal tube at the

Intra-operative Considerations

Microscope & TV system

Drape the microscope after the head preparation has been completed

Preparing the Microscope

Light intensity Drape

Intra-operative Considerations
To standby blood product CT angiography images are available to refer intra-operatively Management of BP by anesthetist

Post-operative Considerations

Immediate Post-operative Care

Monitoring of neurologic exam and vital signs Frequent assessment of airway patency and oxygenation continue IV fluids are maintained to assure adequate hydration Maintaining the systolic pressure at less than 200 mm Hg has been recommended (Suarez, Tarr, & Selman, 2006).

The goal of BP management is to maintain perfusion of brain tissue and prevent ischemia

Continued ICP monitoring.

Prolonged elevations in ICP are associated with decreased cerebral perfusion pressure and increase the risk of cerebral

Post-operative Considerations

promote venous drainage by elevating the head of the bed 20 to 30 degrees. Emotional support of the patient and family is also important. The patient may be dealing with a neurological deficit, such as paralysis on one side of the body or loss of speech. If the patient cannot speak, establish a simple means of communication such as using a slate to write messages or using cards. Encourage the patient to verbalize fears of dependency and of becoming a burden.

Discharge and Home Health Care Guidelines

Prepare the patient and family for the possible need for rehabilitation after the acute care phase of hospitalization. Instruct the patient to report any deterioration in neurological status to the physician. Stress the importance of follow-up visits with the physicians. Be sure the patient understands all medications, including dosage, route, action and adverse effects, and the need for routine lab monitoring if anticonvulsants

References
Jane C. R. (2007). Alexanders care of the patient in surgery (13th ed.). St. Louis, Mosby Elsever. Priscilla L. & Karen B.(2004). Medical surgical nursing- critical thinking in client care (3rd ed.). New Jersey, Pearson Education.

To Find Out More at

http://www.mayoclinic.com/health/brai n-aneurysm/DS00582 http://www.emedicinehealth.com/aneu rysm_brain/article_em.htm