Surgical and endovascular treatments for intracranial aneurysms.

The goals of microsurgical and endovascular treatment of intracranial aneurysms are to prevent subarachnoid hemorrhage and/or eliminate mass effect symptoms. Debate has raged regarding which aneurysms to treat and with which technique or combination of techniques. It is our impression that studies that have assessed aneurysm natural history and treatment options are compromised by the inherent limitations of clinical trials, with many natural history studies likely underestimating rupture risk over long-term follow-up. Endovascular therapy and open neurosurgery should both be used strategically, and our current interest is in integrating these techniques in a fashion extending beyond the simplistic clip-versus-coil debate.