title: A view on the current and future therapy of brain aneurysms.
abstract: While in clinical practice the use of endovascular and microsurgical methods retained relative levels by 2010, since 2008 the research activity has lagged behind that in other medical disciplines. Particularly research on neuroprotection, such as hypothermia and pharmacological measures, has lost impetus, and clinical applications of specific neuroprotective interventions have been largely abandoned. The last substantial advancement for aneurysm surgery was the introduction of intraoperative indocyanine green (ICG) angiography. The technical evolution of endovascular therapy has been somewhat more active than that of microsurgery. It is our conviction that microsurgical methods need to develop a focus particularly on minimal invasiveness and also cosmetic aspects. Teaching remains an important consideration. It appears that an explicit framework is necessary in order to communicate the specific do's, don'ts and hows of aneurysm surgery, i.e., a set of rules addressing general perioperative management, principles of exposure and dissection of the typical configurations, clipping technique and the specific issues concerning very small and very large aneurysms. Quality management has become an unconditional requirement also in neurovascular surgery. At our department we have established a system of identification of complications and monthly case analysis. Despite these efforts combined management morbidity and mortality for ruptured and unruptured aneurysms remains around 10%, which appears to be the achievable degree of safety in unselected patients with the current technology.
authors.affiliation: Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany. steiger@uni-duesseldorf.de
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
mesh_terms: D035843:Biomedical Research / Q000379:methods / Q000639:trends; D002533:Cerebral Angiography; D049674:History, 21st Century; D006801:Humans; D002532:Intracranial Aneurysm / Q000266:history / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000193:education / Q000379:methods / Q000639:trends