The current surgical management of intracranial aneurysms

For more than two decades, surgical clipping of ruptured intracranial aneurysms was considered the standard of care. However, as technology improved, a new treatment option was developed, endovascular emoblization. The treatment of cerebral aneurysms, is now in an era where deciding when to clip versus coil can be difficult. Today's cerebrovascular specialist must consider a multitude of factors when developing the best treatment strategy for an individual patient. Optimal management requires a thorough understanding of the natural history of aneurysms as well as risks and benefits related to the different treatment modalities. The purpose of this article is not to proclaim one treatment better than the other, but rather to provide the reader with an up-to-date, comprehensive insight into the management of cerebral aneurysms. We will review data regarding the natural history of aneurysms along with the effectiveness of both surgical clipping and endovascular embolization. We will further discuss our current management strategy for some of the most common aneurysms encountered. The successful treatment of intracranial aneurysms requires a multidisciplinary approach, where surgery and endovascular therapies are viewed as complimentary instead of competing.