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Background and aims: Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present single-surgeon series provides a balanced overview of the treatment of ruptured aneurysms in surgical clipping and coil embolization.

Background We introduce less invasive technique for superficial temporal to middle cerebral artery (STA-MCA) anastomosis, and also described an innovative technique to preoperatively identify the recipient artery using three dimensional CT angiography (3D CTA).

Recent advancement in microneurosurgery and interventional neuroradiology has brought us a new aspect in the treatment of cerebral aneurysms. There is now a choice of several therapeutic alternatives for the management of cerebral aneurysms. The selection of interventional neuroradiologic techniques with GDC therefore requires consideration of neurosurgical techniques, just as the selection of neurosurgical treatment requires an analysis of endovascular alternatives. The decision for treatment of an individual patient should be based on objective selection of the safest and the most effective treatment. It is self-evident that the primary consideration in the selection process must be the immediate and long-term welfare of the individual patient, rather than the physician’s preference for any specific treatment modality.

Ninety-eight patients with aneurysms of the posterior circulation were admitted to our department from 1993 to 1997. Sixty of them underwent microsurgical treatment, mostly in the acute stage of subarachnoid hemorrhage. Peri- and intraoperative management were carried out according to a structured treatment strategy. Special aspects of surgical technique included extradural selective anterior clinoidectomy for basilar head aneurysms, lateral suboccipital craniotomy and partial condylectomy without laminectomy for aneurysms of the vertebral artery or posterior inferior cerebellar artery, and a trans-Sylvian approach, as used in selective amygdalohippocampectomy, for aneurysms of the posterior cerebral artery. A careful angiographic evaluation of the aneurysms in relation to the neighboring important arteries and bony structures was essential for optimal surgical planning. Forty-nine patients (82%) made a good recovery by 3 months after surgery. The mortality was 7%.

Management of deep-seated arteriovenous malformations AVMs remains a problem, although alternative methods of surgical excision such as stereotactic radiosurgery and superselective embolization have recently been developed. We report the methods and results of the surgical excision of thalamic AVM up to 4 cm in size, mainly via the parieto-occipital transventricular approach in the sitting position using intraoperative angiography. Complete removal was possible in some cases with a low morbidity.

The present report describes the successful treatment of cerebral vasospasm after subar achnoid hemorrhage (SAH) with super selective intra-arterial infusion of papaverine hydrochloride and the experimental background of this treatment. Since in vitro experiment demonstrated that papaverine is one of the most potent vasodilators of human cerebral arteries following SAH, papaverine was applied clinically as a vasodilator for the spastic arteries after SAH. Thirty-seven vascular territories in 10 patients with symptomatic vasospasm were treated by percutaneous transluminal angioplasty (PTA) and superselective infusion of 0.2% papaverine. Thirty-four of 37 vascular territories were successfully dilated. Superselective intraarterial infusion of papaverine is an alternative method of treatment for symptomatic vasospasm.

Embolic materials available to-date are reviewed and classified. Characteristic properties of a newly developed embolic material, ethylene-vinyl-alcohol EVAL copolymer, along with experience of its clinical application are presented. Ease of its handling at the time of embolization and of operation are emphasized.