The future role of neurosurgery in the case of vascular diseases of the central nervous system.

On the basis of 2542 cerebro-spinal vascular diseases (933 aneurysms, 689 cerebro-spinal angiomas, 410 spontaneous intracerebral hematomas, 361 vascular bypass operations and 149 endarterectomies of neck vessels) the present situation and problems, as well as the future prospects of cerebral vascular neurosurgery are reviewed. It is expected that the main development will take place in the field of pathophysiology and pathochemistry of vascular diseases through the acquisition of data obtained not in experimental studies but in patients. This will refine the diagnosis and indications. It is not expected that the operative technique will undergo very substantial change. New methods in the application of laser and photosensitization techniques will be probably included in the technical armamentarium. Endovascular methods of treatment will be further developed and will lead to the limitation of the indications for direct operation. It is assumed that mortality and morbidity can be further reduced by improving the diagnosis and establishing the optimal lines of therapy.