The combination of endovascular and surgical techniques for the treatment of intracranial aneurysms.

Endovascular technique, primarily employing electrolytically detachable platinum coils--the Guglielmi Detachable Coil system--is a viable therapeutic option for the management of many intracranial aneurysms. Inclusion of endovascular techniques into a comprehensive intracranial aneurysm treatment program beneficially extends the options for treatment, and enhances safety and efficacy of aneurysm treatment. Endovascular therapy should be considered not a replacement for surgical clipping, but a welcome addition to the various techniques available for aneurysm treatment. The selection of surgical or endovascular treatment for ruptured and unruptured intracranial aneurysms requires an understanding of the relative physical, anatomical, and physiological characteristics of both endovascular and surgical treatment. This article discusses the selection of endovascular or surgical treatment for an individual patient, which requires a careful consideration of aneurysm-specific and patient-specific characteristics. This article also describes the combination of endovascular and surgical techniques for the management of complex aneurysms. The availability of high quality neurosurgical and endovascular treatment for intracranial aneurysms is expected to provide clinical outcomes superior to those achieved by using either method in isolation.