Brain Aneurysm Surgery in Singapore: A Comprehensive Guide

Learning that you have a brain aneurysm can be overwhelming, and the idea of surgery may feel concerning. Brain aneurysm surgery is a medical intervention aimed at managing the aneurysm and reducing the risk of serious complications such as rupture and haemorrhage. Neurosurgeons use appropriate surgical techniques and equipment to treat aneurysms safely. This guide provides an overview of surgical options, what the procedure involves, and what to expect throughout your treatment journey.

Dr Teo Kejia (张哿佳医生)

Senior Consultant Neurosurgeon

MBBS (SG)MRCS (Edin)FAMS (Neuro Surg)FRCS Ed (Neuro Surg)IFAANS

Brain Aneurysm Surgery in Singapore: A Comprehensive Guide

Overview Candidates Treatment Process Recovery Benefits Risks Cost FAQS Conclusion

What is Brain Aneurysm Surgery?

Brain aneurysm surgery is a neurosurgical procedure to repair or isolate a weakened, bulging area in a brain artery wall. An aneurysm forms when the arterial wall becomes thin and balloons outward. This creates a risk of rupture that could lead to a haemorrhagic stroke (bleeding in the brain caused by a burst blood vessel). Surgery is performed to manage the aneurysm and reduce the risk associated with rupture or bleeding.

There are two main surgical approaches:

Surgical clipping involves placing a metal clip at the base of the aneurysm through open surgery
Endovascular coiling involves inserting platinum coils through blood vessels to fill the aneurysm

Your neurosurgeon will determine the most suitable technique based on factors such as the aneurysm’s size, location, shape, and your overall health.

Ideal Candidates

Individuals who may be considered for brain aneurysm surgery include:

Patients with unruptured aneurysms above a certain size threshold
Individuals with symptomatic aneurysms causing headaches, vision problems, or neurological deficits
Patients with ruptured aneurysms requiring emergency intervention
Those with aneurysms in locations accessible for either surgical clipping or endovascular coiling
Individuals with a family history of aneurysm rupture or multiple aneurysms
Younger patients who may face cumulative rupture risk over time
Patients in adequate general health who can safely undergo anaesthesia and surgery

Contradictions

Certain conditions may prevent or complicate brain aneurysm surgery:

Severe medical conditions that significantly increase surgical risk
Blood clotting disorders that cannot be controlled
Active infections that could affect the surgical site
Very small aneurysms with low risk of rupture
Aneurysms located in areas that are difficult to access surgically
Advanced age with multiple existing medical conditions where risks may outweigh benefits
Reduced neurological function following rupture, where surgical intervention may be limited

A thorough evaluation by a neurosurgeon is essential for determining suitability. Your neurosurgeon will provide recommendations based on your specific situation, carefully considering the characteristics of your aneurysm, your individual health factors, and the relative risks of surgery versus monitoring.

Treatment Techniques & Approaches

Surgical Clipping

Surgical clipping involves a craniotomy to access the aneurysm directly. The neurosurgeon places a small metal clip across the aneurysm’s neck, sealing it off from blood circulation. This technique may be used to treat aneurysms with well-defined necks. Clipping allows the surgeon to remove blood clots, if present, and to inspect the surrounding vessels.

Endovascular Coiling

Endovascular coiling is a minimally invasive approach performed through the blood vessels. A catheter (a thin, flexible tube) is inserted through the femoral artery in the groin and navigated to the brain aneurysm. Platinum coils are then deployed into the aneurysm sac, promoting blood clotting and sealing off the aneurysm. This technique does not require the opening of the skull and generally involves shorter hospital stays. It may be considered for aneurysms in deeper brain locations or patients who may not be suitable for open surgery.

Technology & Equipment Used

Neurosurgical procedures use specialised equipment, including:

High-resolution microscopes allow the surgeon to view extremely small structures in detail
Intraoperative angiography provides imaging of blood vessels during surgery
GPS-like technology that helps guide surgical instruments

These tools help neurosurgeons in locating and managing the aneurysm. Endovascular procedures utilise biplane angiography systems that provide detailed 3D imaging of blood vessels. In selected cases, flow diverters and stent-assisted techniques may be used for complex aneurysm configurations.

Wondering which approach might be suitable for you?

Consult our neurosurgeon to evaluate your specific needs and discuss the available techniques for your individual case.

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The Treatment Process

Pre-Treatment Preparation

Before surgery, patients undergo a comprehensive evaluation, which may include CT or MR angiography to map the aneurysm. Blood tests assess clotting function and overall health status. Patients may need to stop certain medications, particularly blood thinners, several days before surgery. Fasting is required from midnight before the procedure. On the day of surgery, an intravenous line (a thin tube inserted into a vein) is established. Patients may also be given medications to help reduce anxiety.
During the Procedure

For surgical clipping, patients are given general anaesthesia. The head is positioned and secured. The procedure generally lasts several hours. The surgeon creates a bone flap (temporarily removing a section of skull) to access the brain and navigates to the aneurysm using microscopic visualisation (viewing through a specialised microscope). The clip is then placed across the aneurysm’s neck. Intraoperative angiography (imaging performed during surgery) may be used to confirm that the aneurysm has been sealed off from blood flow.
For endovascular coiling, general anaesthesia is also typically used. A catheter system (thin, flexible tubes) is inserted through a blood vessel and navigated to the aneurysm under X-ray guidance. Coils (small wire spirals) are placed inside the aneurysm sac until it is filled. Final angiography may be performed to verify proper coil placement and aneurysm exclusion.
Immediate Post-Treatment

Following surgery, patients recover in the intensive care unit (ICU) for close neurological monitoring, which involves observing brain and nerve function. Vital signs such as heart rate, blood pressure, and breathing are regularly checked, along with neurological function and potential complications.

For surgical clipping, the initial recovery focuses on managing post-craniotomy care, including pain management and monitoring for brain swelling. Patients who undergo endovascular coiling may need to lie flat for several hours to reduce the risk of bleeding at the catheter insertion site. Patients remain in the ICU for a period before transferring to a regular ward.

Recovery & Aftercare

First 24-48 Hours

The immediate post-operative period involves close monitoring. Pain management is provided using medications tailored to each patient’s needs. Patients are encouraged to move their limbs and may begin sitting up as tolerated. Neurological assessments (checks of brain and nerve function, such as testing movement, sensation, and alertness) are performed frequently to detect any changes. The healthcare teams monitor for warning signs, including:

Severe headaches
Vision changes
Weakness
Altered consciousness

Patients who have undergone surgical clipping may experience discomfort at the incision site, while those who have had endovascular coiling might have groin soreness.

First Week

During the first week, patients gradually increase activity levels under supervision. Daily wound care for surgical patients includes keeping the incision clean and dry. Follow-up imaging, such as CT scans or angiography, may be performed to review the treated aneurysm. Those who have had endovascular coiling often return home within a few days, while those who have undergone surgical clipping typically remain in the hospital for a longer period. Light activities, such as walking, are encouraged, but strenuous activities, heavy lifting, and driving are restricted. Patients receive clear instructions regarding medication schedules and warning signs to monitor.

Long-term Recovery

Recovery time varies among patients based on individual health factors and the procedure performed. Surgical clipping may require several weeks for the skull to heal fully, while coiling patients often resume normal activities sooner.

Regular follow-up appointments include imaging studies to monitor the aneurysm. Long-term imaging may be less frequent after clipping, whereas patients who have undergone coiling may require periodic angiography to check for coil compaction or changes in the aneurysm.

Some patients may benefit from rehabilitation services, including physiotherapy, occupational therapy, or speech therapy, to address any remaining neurological effects.

Consult our neurosurgeon for guidance on post-procedure care and follow-up. Schedule a consultation to discuss your personalised recovery plan and follow-up care.

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Benefits of Brain Aneurysm Surgery

Brain aneurysm surgery is considered for selected patients based on clinical assessment and individual circumstances, such as:

Risk of aneurysm rupture
Presence of symptoms caused by aneurysm pressure on surrounding structures (e.g., headaches, vision changes, facial discomfort)
Size, shape, and location of the aneurysm
Requirements for follow-up imaging and monitoring
Patient preferences after discussion of treatment approaches

For ruptured aneurysms, surgery is performed to manage active bleeding and reduce the risk of further complications. Surgical clipping involves placing a small metal clip at the aneurysm base to exclude it from blood flow. Our neurosurgeon can discuss the treatment approaches that may be appropriate for your individual case during a consultation.

Risks & Potential Complications

Common Side Effects

Temporary effects may occur following brain aneurysm surgery and are generally managed with standard post-operative care. These can include:

Headaches, which may be relieved with pain medication over several weeks
Fatigue and difficulty concentrating during recovery
Scalp numbness around the incision after surgical clipping, which often improves over months
Mild swelling at the surgical site
Temporary changes in sleep patterns or mood, which usually normalise during recovery

Potential Complications

Serious complications can occur with brain aneurysm surgery, including:

Stroke due to blood vessel injury or vasospasm (sudden narrowing of blood vessels, reducing blood flow to the brain)
Infection at the surgical site or deeper brain structures
Seizures, particularly after clipping procedures
Aneurysm recurrence following coiling, which may require retreatment
Hydrocephalus (fluid accumulation in the brain) following subarachnoid haemorrhage

Cost Considerations

The cost of brain aneurysm surgery in Singapore varies based on several factors:

Choice of procedure: Surgical clipping or endovascular coiling
Complexity, size, and location of the aneurysm
Length of hospital stay and intensive care requirements
Use of specialised equipment or materials (clips, coils, stents)
Pre-operative investigations and imaging studies
Post-operative rehabilitation services, if required
Follow-up imaging and consultations

Surgical costs generally include surgeon fees, anaesthesia services, operating theatre charges, hospital accommodation, nursing care, and immediate post-operative imaging. Additional expenses may arise if complications occur or extended rehabilitation is required.

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Frequently Asked Questions

How urgent is brain aneurysm surgery if my aneurysm hasn’t ruptured?

The urgency of the surgery depends on several factors, including the aneurysm’s size, location, and growth rate. Larger aneurysms may require prompt treatment due to a higher risk of rupture. Smaller aneurysms may be monitored with regular imaging (such as CT or MRI scans) unless they show growth or cause symptoms.

Your neurosurgeon will assess your individual risk based on several factors:

Aneurysm characteristics
Age
Family history
Overall health

Some patients may be advised to have surgery sooner, while others may safely postpone surgery for weeks or months. Our neurosurgeon will determine the appropriate timing based on your specific situation.

What’s the difference in recovery between clipping and coiling?

Recovery differs between these approaches. Endovascular coiling typically involves:

Shorter hospital stays (a few days versus approximately a week)
Less post-operative pain
Faster return to normal activities (a few weeks versus several weeks)

Coiling may require more frequent follow-up imaging to monitor the aneurysm.

Surgical clipping generally involves a longer initial recovery period. It may require additional time for the skull and surrounding tissues to heal. Clipping usually involves less frequent long-term imaging once the aneurysm has been treated.

Can a treated aneurysm recur?

The likelihood of aneurysm recurrence depends on the treatment method and aneurysm characteristics.

Surgical clipping generally has low recurrence rates, as the aneurysm is physically excluded from blood circulation.
Endovascular coiling may have higher recurrence rates, particularly for larger aneurysms, due to coil compaction (when coils settle or compress) or aneurysm growth.

Regular follow-up imaging allows healthcare providers to monitor the aneurysm over time. If recurrence is detected, additional treatment options may include:

Repeat coiling
Surgical clipping
Flow diverter placement (a mesh tube that redirects blood flow away from the aneurysm)

Our neurosurgeon can recommend the most appropriate approach based on your specific situation.

What activities will I need to avoid after surgery?

Activity restrictions depend on the procedure and stage of recovery. Initially, all patients are advised to avoid:

Strenuous activities
Heavy lifting
Straining

Driving is usually restricted for a few weeks or until cleared by your neurosurgeon. Contact sports and high-impact activities may require longer restrictions, often several months. Swimming may be limited until the surgical site has fully healed. Air travel is generally safe after a few weeks, but medical clearance is recommended.

Long-term restrictions are minimal for most patients, though some may need to avoid activities with a higher risk of head injury. Our neurosurgeon will provide guidance tailored to your individual recovery.

Will I need rehabilitation after brain aneurysm surgery?

Rehabilitation requirements vary depending on the type of surgery and individual recovery. Patients who undergo uncomplicated surgery for unruptured aneurysms may only need gradual activity resumption and routine outpatient follow-up.

Those recovering from ruptured aneurysms or experiencing neurological effects, such as weakness, difficulty speaking, or balance issues, may benefit from structured rehabilitation, which can include:

Physical therapy
Occupational therapy
Speech therapy
Cognitive rehabilitation for memory or concentration difficulties

What follow-up care is required after surgery?

Follow-up care helps monitor recovery and detect any changes after brain aneurysm surgery. Initial post-operative visits usually occur within a few weeks to check wound healing and neurological function. Imaging studies such as CT or MR angiography may be performed after several months to review the treated aneurysm.

Patients who had endovascular coiling may need more frequent imaging, often annually for the first few years, and less often if stable.
Patients who had surgical clipping may require occasional imaging after initial review.

Regular clinical assessments allow our neurosurgeon to monitor for any new symptoms or changes in neurological function. Follow-up schedules are tailored to each patient’s specific situation.

Conclusion

Brain aneurysm surgery is a treatment option that may help reduce the risk of complications. In Singapore, surgical clipping or endovascular coiling can be considered based on individual aneurysm characteristics and overall health. Careful evaluation and follow-up support safe treatment and ongoing monitoring.

Ready to Take the Next Step?

If you’re considering brain aneurysm surgery, consult our Senior Consultant Neurosurgeon to discuss whether this intervention is suitable for your individual condition and medical history.

Book Your Consultation Today

Dr Teo Kejia 张哿佳医生

Senior Consultant Neurosurgeon

MBBS (SG)●MRCS (Edin)●FAMS●FRCS Ed●IFAANS

Dr Teo Kejia is an experienced Senior Consultant Neurosurgeon and Director at Precision Neurosurgery.

Dr Teo has extensive knowledge and experience in the field of neurosurgery, with a particular focus on complex brain tumour procedures. He is adept in employing advanced surgical techniques, including brain mapping and awake brain surgery, especially for treating gliomas and glioblastomas. His expertise extends to neuro-oncology, encompassing both brain and spinal tumours, as well as neurovascular and skull base surgery.

Additionally, Dr Teo offers treatment for a range of neurological conditions, such as traumatic head injuries, intracerebral aneurysms, and degenerative spine disorders, which include neck and back pain. He is also proficient in managing ischemic and haemorrhagic strokes, hydrocephalus, trigeminal neuralgia, and hemifacial spasm.

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