Intracranial vascular surgery

To review the recent literature on intracranial vascular surgery, to summarize the main findings, and to discuss the impact of these findings on clinical practice.

Three areas of vascular neurosurgery literature have recently generated significant interest, controversy and heated debate: (1) The International Study of Unruptured Intracranial Aneurysms studied the natural history and treatment options of unruptured aneurysms, and reported surprisingly low aneurysm rupture rates for small asymptomatic aneurysms. The study also reported favorable morbidity rates for endovascular treatment compared with surgical treatment of unruptured aneurysms. (2) The International Subarachnoid Aneurysm Trial compared endovascular and surgical treatments for ruptured intracranial aneurysms. The study concluded that the outcome in terms of survival free of disability at one year was significantly better with endovascular coiling. (3) The Intraoperative Hypothermia for Aneurysm Surgery Trial compared intraoperative hypothermia and normothermia for potential neuroprotection during neurovascular procedures. Preliminary results suggest no difference between the treatments.

The International Study of Unruptured Intracranial Aneurysms and the International Subarachnoid Aneurysm Trial have provided data on the natural history of unruptured intracranial aneurysms and on the morbidity and mortality of surgical and endovascular treatments for intracranial aneurysms. Although morbidity rates of endovascular therapy compare favorably with those of surgery, long-term data on the efficacy of endovascular coiling of aneurysms are needed to assess the overall risk-benefit ratio of these therapies.