Principles and Techniques of Surgical Management of Ruptured Cerebral Aneurysms

Abstract

Endovascular intervention has become a major treatment modality for cerebral aneurysms since the advent of the detachable coil in 1990. It is currently recommended as the first choice of treatment for ruptured aneurysms. Nonetheless, surgical treatment is still a major modality, and the degree of difficulty is relatively higher in cases which cannot be effectively managed using endovascular interventions and are therefore referred to the surgical arm. When performing a surgery for a ruptured aneurysm, it is very important to adhere to general principles, such as brain relaxation, dissection, parent artery control, and clipping techniques, and to gain experience in a variety of situations to achieve favorable outcomes and decrease surgical complications. In addition, specific considerations vary according to the locations of the aneurysms. The representative locations of the aneurysms include the internal carotid artery (paraclinoid segment of internal carotid artery, posterior communicating artery, anterior choroidal artery, and bifurcation of the internal carotid artery), anterior cerebral artery (anterior communicating artery and distal segment), middle cerebral artery (proximal, distal and bifurcation segments), and posterior circulation (posterior cerebral artery, basilar bifurcation, basilar trunk, superior/anterior inferior/posterior inferior cerebellar artery, and vertebral artery). The aim of this study is to describe the general principles and specific surgical considerations to consider in aneurysms based on the authors’ experiences and reports in the literature.