First Day In Neurosurgery! - Part two: Finding an aneurysm

A 7cm section of the skull was removed and we started dissecting at the meningeal layers of the brain. Small cuts were made, and the tears were gradually made larger. Stroke by stoke we got to the core of the human mind.


Now the surgeon gave me specific instructions. He put some sort of brace on the head and with it came two adjustable arms. These arms were to be placed inside the brain as a sort of spade, and then we would pull the arms apart and make space. I would then need to lock the arms in place, so that they did not move.


The rest of it was uneventful. We found the internal carotid artery (ICA) and then I learnt that we were looking for an aneurysm. Finally, I had learnt what I just drilled into somebody’s skull for. The surgeon asked me a few anatomy questions. I got them all wrong. Standard.


A long period had already passed. Maybe 4 hours now. We had found the ICA, had cleared around the artery and then moved up the artery and cleared some more and we rinsed and repeated. The only thing stopping me from dropping dead from being bored, was the adrenaline in that if I messed up in any way, in a split second, I could kill or severely disable the patient in front of me. It kept me wide awake. Then…


The artery BALLOONED! From a small artery around 1cm in diameter it just increased to SEVEN CM! This thing was HUGE. It pulsated like a heart. It was disgusting…


This was the aneurysm! I had never seen something like this in my entire life. It’s astounding how that managed to fit in his skull. Its astounding that his brain was content being fit around it.


Hours passed, as a clearer view and path to the aneurysm was made. I’m not sure how large this aneurysm was compared to other aneurysms, but the theatre became quite a theatre, with all the neurosurgeons coming to watch after their respective surgeries had ended. Surgeons talked amongst each other ‘is that the neck?’ ‘is that m2?’ I had (and still have) no clue what they were talking about.


The treatments for brain aneurysms are neurosurgical clipping or coiling. Coiling is usually made under general anaesthetic and involves inserting small platinum coils into the aneurysm to stop blood flow through it. Clipping is the addition of small metal clips which clamp onto the artery to prevent the blood flow. This is usually chosen for larger aneurysms.


I’m not sure how many clips are usually attached to the artery, but one definitely wasn’t enough. The aneurysm still bulged out like an unwanted prick. Two clips weren’t enough…. In the end 5 clips were attached to put hinder the blood flow enough, such that the aneurysm had deflated back down to a respectable size.


By this time, I had gotten dreadfully bored. This has been my second longest surgery. I asked to scrub out and then just sat down on the side and played a stupid game on my phone, whilst the main surgeon finished.


N.B. The longest surgery I have been scrubbed in for was a renal transplant. It was an emergency case, and I was not expecting to be a part of this, I was more so dragged into it. I used to think surgery was cool, but I can’t stand operating for so long. I guess I’ll never be a surgeon.



Written by: Jamil Shah Foridi


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