Modern treatment of intracranial aneurysms

The initial physical and neurologic examinations usually allow a presumptive diagnosis of intracranial aneurysm, but confirmation may require computed tomography (CT) and selective angiography. Medical management of the patient necessitates close observation, supportive care, and use of drugs to reduce intracranial pressure and to prevent dissolution of clot at the aneurysmal fundus to prevent rebleeding. The age of the patient may be a deciding factor in selection of surgical candidates. The surgical procedure of choice is direct obliteration of the aneurysm by clipping or ligation, unless such a procedure would compromise the patency of major intracranial vessels or not be possible because of the shape of the aneurysm. With aggressive medical management and modern surgical techniques, many more of these patients may be saved and returned to productive life.