Endovascular aneurysm treatment from the neurosurgeon's point of view.

Recent advancement in microneurosurgery and interventional neuroradiology has brought us a new aspect in the treatment of cerebral aneurysms. There is now a choice of several therapeutic alternatives for the management of cerebral aneurysms. The selection of interventional neuroradiologic techniques with GDC therefore requires consideration of neurosurgical techniques, just as the selection of neurosurgical treatment requires an analysis of endovascular alternatives. The decision for treatment of an individual patient should be based on objective selection of the safest and the most effective treatment. It is self-evident that the primary consideration in the selection process must be the immediate and long-term welfare of the individual patient, rather than the physician's preference for any specific treatment modality. Although GDC embolization has been successful in preventing acute subsequent bleeding of aneurysms, incomplete endovascular occlusion of aneurysm leaves the patient at risk for future expansion and future subarachnoid hemorrhage. With this limitation in mind, patients need to be very carefully chosen for GDC embolization. Endovascular treatment of intracranial aneurysms with GDCs has thus been limited to adjuvant or palliative indications for many patients.