Strategies of neuroprotection for intracranial aneurysms

Neuroprotection for patients with intracranial aneurysms encompasses the preservation of brain cells endangered by a limited blood and oxygen supply due to aneurysm rupture, clipping or coiling, as well as vasospasm. A large variety of prophylactic and therapeutic neuroprotective strategies have been proposed, but success in human disease is quite limited. Topics of this chapter are the pathophysiology and treatment options of aneurysms, as well as promising neuroprotective strategies in further developmental stages: both physiologically based (hyperoxygenation, hypothermia, avoidance of hyperthermia and hyperglycaemia, hypertension, haemodilution and hypervolaemia) and pharmacologically based (antifibrinolytic drugs, calcium antagonists, anaesthetics, magnesium, erythropoietin and others). New concepts are ischaemic preconditioning, growth factors, and gene therapy. Each strategy is rated on underlying evidence, and research agendas are mentioned.