Current Concepts in the Management of Cerebral Aneurysms

Cerebral aneurysms represent a heterogeneous group of vascular lesions whose clinical behavior ranges from incidental, asymptomatic findings to catastrophic aneurysmal subarachnoid hemorrhage. Despite major advances in neuroimaging, microsurgical technique, and endovascular technology, the management of both ruptured and unruptured cerebral aneurysms remains complex and highly individualized. This review examines current concepts in aneurysm pathobiology, natural history, risk stratification, and contemporary treatment strategies, emphasizing durable clinical principles that transcend evolving technology. Particular attention is given to the balance between conservative surveillance and intervention in unruptured aneurysms, as well as the time-critical priorities, complications, and neurocritical care considerations in ruptured aneurysms. The relative roles of microsurgical and endovascular therapies are discussed through the lens of long-term durability, retreatment risk, and patientspecific anatomy. Ultimately, optimal outcomes depend less on any single technique than on disciplined clinical judgment, longitudinal thinking, and true interdisciplinary collaboration within experienced neurovascular centers.