What it is
Aneurysm clipping is an open microsurgical procedure in which the neurosurgeon performs a craniotomy — a planned opening in the skull — to reach the aneurysm at the base of the brain, dissect it free from the surrounding structures, and place a small titanium clip across its neck. The clip excludes the aneurysm from the arterial circulation permanently, eliminating the risk of rupture. Once clipped, aneurysms do not recur at the same site, which is a meaningful advantage over endovascular coiling in terms of long-term durability.
Clipping versus coiling
Both clipping and endovascular coiling (and more recently, flow diversion) are established treatments for cerebral aneurysms. The ISAT trial compared outcomes for ruptured aneurysms suitable for both techniques and showed better early outcomes with coiling, driving a shift toward endovascular approaches over the past two decades. However:
- Clipping remains the preferred approach for certain aneurysm anatomies — particularly wide-necked aneurysms, middle cerebral artery aneurysms, and those with a branch arising from the aneurysm dome that cannot be preserved with coiling.
- Clipping provides more durable occlusion — long-term retreatment rates after clipping are substantially lower than after coiling.
- Ruptured aneurysms in the setting of intracerebral hematoma often require surgical evacuation regardless, making clipping the natural choice.
The decision between clipping and coiling is made collaboratively between neurosurgery and interventional neuroradiology, informed by aneurysm anatomy, patient condition, and institutional experience.
What to expect
For ruptured aneurysms, surgery is typically performed urgently to prevent re-bleeding. Recovery depends heavily on the severity of the subarachnoid hemorrhage and any associated brain injury. For unruptured aneurysms treated electively, hospital stay is typically three to five days with a recovery period of two to four weeks at home.