A raised bar for aneurysm surgery in the endovascular era

Key points:

  • To review advances in surgical treatment of aneurysms;
  • To highlight the importance of continued training in microsurgical techniques.

Despite microsurgical treatment of cerebral aneurysms has a documented history, the impressive progression of endovascular technology, techniques and skills, and the results of the International Subarachnoid Aneurysm Trial (ISAT) and the Barrow Ruptured Aneurysm Trial (BRAT) has altered the paradigm for treating intracranial aneurysms. These neurointerventional option have raised the bar for aneurysm surgery, in an era when most of the neurosurgery residents complete their training after having treated few brain aneurysms. In this paper, published online February 24, 2017 on Journal of Neurosurgery, Authors review advances in surgical treatment of aneurysms and highlight the importance of continued training in microsurgical techniques. Following useful neurosurgical tips and tricks:

Minimally Invasive Tailored Craniotomies

Retractorless Surgery

Adjuncts for Aneurysm Exposure

Circulation arrest

Intraoperative Confirmation of Aneurysm Occlusion

Revascularization Techniques for Difficult Aneurysms

In conclusion, the advent of novel tools and techniques are evolving the treatment of cerebral aneurysms and upcoming studies probably will change our perspectives; the application of progenitor cell or regenerative medicine approaches to assist the healing of injured vessels wall or the application of genome sequencing to identify biological pathways involved in endothelial cell damage are the future frontiers. But for now, are neurosurgery and interventional neuroradiology antagonists or they rapresent a single arsenal for the best treatment of patients?


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