To prevent recurrent bleeding (rebleeding/rebleeding), a ruptured (ruptured) aneurysm must be rapidly separated from the bloodstream. This can be done surgically by clipping or endovascularly (“within a vessel”) by coiling (within the first 72 hours after the onset of the first symptoms, i.e. before the onset of possible vasopasms). The earlier a ruptured aneurysm is eliminated (ideally by day 2 after subarachnoid hemorrhage ), the better the prognosis.
- Clipping-open microsurgical operation.
- Procedure: after opening the skull, the aneurysm is isolated (“closed from the outside”) at its neck/base with a titanium clip. The blood supply is thus interrupted.
- Advantages:
- Safe closure of the ruptured aneurysm.
- Low risk of a new rupture
- Particularly suitable for aneurysms with a wide neck/base
- During the procedure, a cerebrospinal fluid drainage can be placed in parallel
- Disadvantages:
- It is an invasive procedure
- This procedure is not suitable for every localization
- During the operation it can come to a new rupture
- Caveat: This procedure is only possible in the absence of vasospasm, usually within the first two days after SAB.
- Coiling (coils = metal spirals) – neurosurgical angiography-based procedure for endovascular embolization (using catheters); 50-85% of aneurysms are treated endovascularly (standard procedure).
- Procedure: coils are placed inside the aneurysm and occlude it.
- Advantages:
- Less invasive
- In the course, a lower rate of cognitive impairment is observed
- Disadvantages:
- Complete closure of the aneurysm is not always possible
- Follow-up by angiography required (after 6-12 months).
