title: Treatment of ruptured intracranial aneurysms yesterday and now.
abstract: OBJECTIVE
  This prospective study is designed to detect changes in the treatment of ruptured intracranial aneurysms over a period of 17 years.
  
  
  METHODS
  We compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. Specialists of neuroradiology and vascular neurosurgery decided over the modality assignment. We established a prospective data acquisition in both groups to detect significant differences within a follow-up time of one year. With this setting we evaluated the treatment methods over time and compared endovascular with microsurgical treatment.
  
  
  RESULTS
  When compared to the earlier group, microsurgical treatment was less frequently chosen in the more recent collective because of neck-configuration. Endovascular treatment was chosen more frequently over time (31.9% versus 48.8%). Occurrence of initial symptomatic ischemic stroke was significantly lower in the clipping group compared to the endovascular group and remained stable over time. The number of reinterventions due to refilled treated aneurysms significantly decreased in the endovascular group at one-year follow-up, but the significantly better occlusion- and reintervention-rate of the microsurgical group persisted. The rebleeding rate in the endovascular group at one year follow-up decreased from 6.1% to 2.2% and showed no statistically significant difference to the microsurgical group, anymore (endovascular 2.2% versus microsurgical 0.0%, p = 0.11).
  
  
  CONCLUSIONS
  Microsurgical clipping still has some advantages, however endovascular treatment is improving rapidly.
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hammer
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Anahi
authors.initials: A
authors.lastname: Steiner
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Kerry
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Ranaie
authors.affiliation: Institute of Radiology and Neuroradiology, Klinikum Nuremberg, Nuremberg, Bavaria, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Baer
authors.affiliation: Department of Anatomy 2, University of Erlangen-Nuremberg, Universitätsstraße 19, Erlangen, Bavaria, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Hammer
authors.affiliation: Department of Neurosurgery, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kunze
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Hans-Herbert
authors.initials: HH
authors.lastname: Steiner
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome