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Semin Neurol 2013; 33(05): 476-487
DOI: 10.1055/s-0033-1364217
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Cerebral Aneurysms—Surgical Clipping or Endovascular Coiling: The Guiding Principles

Ravishankar Shivashankar
1   Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
,
Timothy R. Miller
1   Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
,
Gaurav Jindal
1   Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
,
J. Marc Simard
2   Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland
4   Department of Physiology, University of Maryland Medical Center, Baltimore, Maryland
,
E. Francois Aldrich
2   Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland
,
Dheeraj Gandhi
1   Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
2   Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland
3   Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2014 (online)

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Abstract

Cerebral aneurysms represent common intracranial vascular lesions encountered in neurosurgical practice. The clinical presentation is varied, ranging from asymptomatic lesions to those presenting with catastrophic intracranial hemorrhage. Aneurysm treatment has been a rapidly evolving field with numerous technical innovations, especially in the last two decades. Selecting the appropriate treatment can be a complex process that involves integration of information regarding the patient's clinical presentation, associated comorbidities, the aneurysm's morphological characteristics, safety and efficacy of the treatment options and skill and experience of available practitioners, amongst others. In this article, we review each of these factors and appraise the available scientific evidence in an effort to facilitate decision making in the treatment of cerebral aneurysms. The treatment of intracranial aneurysms is best performed at high volume centers that utilize a multidisciplinary, team-based approach.

Keywords

intracranial aneurysm - surgical clipping - endovascular coiling
 

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