From Clipping to Coiling and Beyond: Mapping the Evolution and Future Directions of Intracranial Aneurysm Research

Background/Objectives: Intracranial aneurysm (IA) management has evolved from surgical treatment of ruptured lesions into a multidisciplinary field integrating diagnostics, neurocritical care, endovascular techniques, and individualized risk assessment. As the literature has grown beyond the scope of traditional narrative synthesis, bibliometric methods are needed to characterize the field's development. We used co-word analysis to map the conceptual structure and thematic evolution of IA research over nearly eight decades. Methods: We analyzed 22,061 publications indexed in PubMed between 1946 and 2023. Co-word analysis of Medical Subject Headings tracked thematic development across six subperiods grouped into eras. Within each thematic network, topics were classified by centrality and density as motor, niche (highly developed but isolated), emerging or declining, or basic themes. Results: Four historical eras were delineated as an interpretative synthesis of the six subperiods. The open-surgery era (1946-1980) centered on ruptured aneurysms and refinement of operative techniques. The transitional era (1981-1990) was marked by proactive vasospasm management and emerging neurocritical care. The endovascular era (1991-2010) reflected the rise of evidence-based medicine and endovascular therapy. The multidisciplinary era (2011-2023) shifted toward unruptured aneurysms, molecular research, biomechanics, and individualized risk stratification. Recent themes, including hemodynamics, flow diversion, and precision medicine, reflect a growing research emphasis on predictive and personalized approaches to aneurysm management. Conclusions: IA research has evolved from descriptive, technique-oriented studies toward a data-driven landscape increasingly focused on predictive assessment and management of unruptured lesions. Its thematic evolution highlights the growing prominence of molecular and computational approaches, although their clinical and translational impact cannot be directly inferred from the present analysis.