Brain Brain AneurysmAneurysm

Fan xiu lanLu qiao xian

Cerebral or Brain Cerebral or Brain AneurysmAneurysmA 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 AneurysmBrain Aneurysm1-2% of the population have

unruptured aneurysmsAny 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 BrainAnatomy of BrainLocated 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 body’s central nervous system.

20%

5%

30-35%

30-35%

Types of Brain AneurysmTypes 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 AneurysmTypes of Brain Aneurysm

Fusiform AneurysmAn 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 AneurysmTypes Of Brain Aneurysm

Pre-operative Pre-operative ConsiderationsConsiderationsTwo diathermy machineTwo suction machinePositioning devices are readyMicroscope and Micro instrumentsBipolar bayonetLegend and toolsTheatre set upTo standby blood productCT angiography imagesHaemostatic agent: Floseal and surgicel

Positioning Positioning Devices Devices Mayfield Clamp Device

◦ attachments

Positioning Positioning DevicesDevicesSugita Head Frame

Pre-operative PreparationPre-operative PreparationAneurysm clips and appliers

(minimum 2) of the surgeon’s choice must be available

Pre-operative PreparationPre-operative PreparationThe environment should be as quiet as possible,

with minimal physiological and psychological stress. Elevate the head of the trolley 30 to 45 degreesLimit visitors to immediate family and significant

others. Discourage and control any measure that initiates

Valsalva’s 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 bedside)

Intra-operative Intra-operative

ConsiderationsConsiderations

Microscope & TV Microscope & TV systemsystem

Drape the microscope after the head preparation has been completed

Preparing the Preparing the MicroscopeMicroscope

Light intensityDrape

Intra-operative Intra-operative ConsiderationsConsiderationsTo standby blood productCT angiography images are

available to refer intra-operativelyManagement of BP by anesthetist

Post-operative Post-operative ConsiderationsConsiderations

Immediate Post-operative Immediate Post-operative CareCare

Monitoring of neurologic exam and vital signs Frequent assessment of airway patency and

oxygenation continueIV fluids are maintained to assure adequate

hydrationMaintaining 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 ischemiaContinued ICP monitoring.

◦ Prolonged elevations in ICP are associated with decreased cerebral perfusion pressure and increase the risk of cerebral ischemia and poor outcome (Suzuki et al., 2000).

Post-operative Post-operative ConsiderationsConsiderationspromote 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 Discharge and Home Health Care GuidelinesCare 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 have been prescribed

ReferencesReferencesJane C. R. (2007). Alexander’s 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…To Find Out More at…http://www.mayoclinic.com/healt

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