1. The evolution of intracranial aneurysm treatment techniques and future directions
- Author
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Lee, Keng Siang, Zhang, John JY, Nguyen, Vincent, Han, Julian, Johnson, Jeremiah N, Kirollos, Ramez, Teo, Mario, Lee, Keng Siang [0000-0003-2308-0579], Zhang, John JY [0000-0002-8567-3807], Johnson, Jeremiah N [0000-0003-4743-911X], Teo, Mario [0000-0002-0051-3303], and Apollo - University of Cambridge Repository
- Subjects
Microsurgery ,Endovascular Procedures ,Clipping ,Flow diversion ,Intracranial Aneurysm ,Embolization, Therapeutic ,Treatment Outcome ,Humans ,Stents ,Subarachnoid hemorrhage ,Aneurysms ,Coiling ,Endovascular embolization ,Retrospective Studies - Abstract
Treatment techniques and management guidelines for intracranial aneurysms (IAs) have been continually developing and this rapid development has altered treatment decision-making for clinicians. IAs are treated in one of two ways: surgical treatments such as microsurgical clipping with or without bypass techniques, and endovascular methods such as coiling, balloon- or stent-assisted coiling, or intravascular flow diversion and intrasaccular flow disruption. In certain cases, a single approach may be inadequate in completely resolving the IA and successful treatment requires a combination of microsurgical and endovascular techniques, such as in complex aneurysms. The treatment option should be considered based on factors such as age; past medical history; comorbidities; patient preference; aneurysm characteristics such as location, morphology, and size; and finally the operator's experience. The purpose of this review is to provide practicing neurosurgeons with a summary of the techniques available, and to aid decision-making by highlighting ideal or less ideal cases for a given technique. Next, we illustrate the evolution of techniques to overcome the shortfalls of preceding techniques. At the outset, we emphasize that this decision-making process is dynamic and will be directed by current best scientific evidence, and future technological advances.
- Published
- 2022
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