Microsurgical treatment of unruptured intracranial aneurysms. A consecutive surgical experience consisting of 450 aneurysms treated in the endovascular era.

BACKGROUND: With the progressive refinement of endovascular techniques, fewer IAs are being treated with open microsurgery. There is limited information regarding the impact of this trend on the ability of younger neurosurgeons to achieve proficiency in the surgical management of IAs. We describe a consecutive series of patients with unruptured IAs treated by a neurosurgeon initiating a dedicated cerebrovascular practice in the "endovascular era."
METHODS: We retrospectively reviewed the records of all patients who had undergone surgical repair of a saccular IA by one neurosurgeon upon completion of neurosurgical training in July 1997 until April 2005. Patients with ruptured IAs were excluded from review.
RESULTS: Of the 1450 patients with IAs treated during this period, 376 underwent microsurgical repair of 450 unruptured IAs. Microsurgical aneurysm neck clipping was possible in most cases, although distal revascularization with proximal occlusion was used in many of the more complicated aneurysms. Major complications occurred in 6 (1.60%) patients, and 1 (0.27%) patient died. At the time of 6-month follow-up, 4 (1.06%) patients were left with a new focal neurologic deficit related to surgery.
CONCLUSIONS: Despite the growing role of endovascular therapy in the management of IAs, it is possible for young neurovascular surgeons to achieve acceptable results with open microsurgical treatment of IAs. The factors that were deemed important in achieving success in this series included a collaborative approach with endovascular colleagues, careful surgical judgment, continual reanalysis of personal results, and early support from experienced mentors.