Craniotomy for treatment of aneurysms

Mitchell, P

doi:10.1017/CBO9780511659096.043

Craniotomy for treatment of aneurysms

Downloads

Full text for this publication is not currently held within this repository. Alternative links are provided below where available.

Abstract

© Cambridge University Press 2014. Indications Prior to the early 1990s, the only means of securing cranial aneurysms was with surgery. Of the techniques of Huntarian ligation, wrapping, and clipping, clipping came to be the favored default option. The early 1990s saw the introduction of endovascular coil embolization, which spread rapidly in popularity because of its minimally invasive nature. This spread was accelerated by the results of the ISAT trial that became available in 2002 [1], showing that in the short term at least, endovascular treatment was the safer option. The argument about the long-term security of the treatment continued for several years. With more recent publication of long-term follow-up from the ISAT trial it has become clear that the increase in hemorrhage rates feared after coiling has not materialized, at least up to about 10 years after treatment [2-4]. This coupled with the natural history suggests that treatment of aneurysms should be primarily aimed at securing them in the short to medium term. In the longer term, beyond 5years or so, it would appear that the re-hemorrhage rate from aneurysms is fairly similar, and very low, whether they are coiled, clipped, or probably even if they are untreated. Endovascular treatment has become the option of choice. Surgical craniotomy is therefore undertaken only in cases where endovascular treatment is either not available or deemed unsuitable.