Gordon Murray lecture. Evolution of intracranial aneurysm surgery

In the late 19th and first half of the 20th centuries, intracranial aneurysms were seldom treated and when they were, Hunterian occlusion of the carotid artery was almost always performed. Although a few pioneer intracranial procedures were done in the 1930s, it was not until after World War II that a major effort was made to obliterate aneurysms during craniotomy. Rebleeding before operation and ischemia with vasospasm were the chief causes of the high morbidity associated with early surgical attempts and even now they remain a problem. However, since the operating microscope was introduced and with modern neuro-anesthesia, intracranial surgery has become routine and reasonably safe, especially since simple modification of the ischemic syndrome by volume expansion and hypertension has proved effective. A return to early operation is now under evaluation. Treatment of aneurysms on the basilar circulation came later and experience in dealing with giant aneurysms on both the carotid and basilar systems is now accumulating.