The evolution of intracranial aneurysm clipping: a historical perspective

Intracranial aneurysms are serious vascular conditions that pose a significant risk of life-threatening subarachnoid hemorrhage (SAH) if ruptured. Over the past century, the surgical management of aneurysms has undergone remarkable advancements, with aneurysm clipping emerging as a cornerstone treatment. This review traces the historical evolution of aneurysm clipping, from the formidable challenges of early 20th-century brain surgery to the sophisticated techniques used today. Key milestones include Victor Horsley's pioneering ligation methods, Harvey Cushing's foundational neurosurgical principles, and Walter Dandy's groundbreaking intracranial aneurysm clipping in 1937. Technological innovations have played a crucial role in advancing the field. The introduction of the operating microscope by M.G. Yasargil in the 1960s and Charles Drake's fenestrated clip design in 1969 significantly improved surgical precision and outcomes. The emergence of endovascular techniques, particularly Guglielmi's detachable coils (GDC) in the 1990s, provided a minimally invasive alternative to clipping. Today, both approaches remain valuable, with treatment selection based on aneurysm characteristics and patient-specific factors. Modern aneurysm clipping has further benefited from cutting-edge imaging technologies, intraoperative monitoring systems, and refined clip designs, enhancing both safety and efficacy. Landmark comparative studies, such as ISAT and BRAT, have provided critical evidence guiding treatment strategies and optimizing patient outcomes.