Evolution of intracranial aneurysm treatment: From Hunterian ligation to the flow diverter

Abstract

Background: Intracranial aneurysm rupture has the highest levels of mortality and morbidity among all stroke types. To answer the question of how and why different well-established and novel treatment techniques were developed, it is crucial to understand the historic hurdles and breakthroughs in intracranial aneurysm treatment over the years. Methods: Literature review was carried out using PubMed and the electronic database of Surgical Practice. Relevant articles were retrieved for further appraisal. Results: The neuro-endovascular treatment field has evolved from the use of detachable balloons or coils to the use of bioactive coils, balloon test occlusion, the balloon-and stent-assisted techniques, and the flowdiverting stent. The application of intraoperative indocyanine green angiography has also improved microsurgical treatment in recent years. Conclusions: Advances in endovascular technology have made coiling the cornerstone of intracranial aneurysm treatment. However, the roles played by different endovascular tools need to be better understood.

Current status of computational fluid dynamics for cerebral aneurysms: The clinician’s perspective

“…Moreover, with flow diverters gaining momentum in aneurysm treatment, it is crucial to understand how such diverters work and perhaps when to avoid them. 5,6 Computational fluid dynamics (CFD) has been proposed as a promising tool in this arena, and we herein review the current understanding of CFD from the clinician's perspective. A PubMed search from 1 January 1970 to 30 November 2010 was carried out using the keywords ''computational fluid dynamics'' AND ''cerebral aneurysm''.…”

Distance and force visualisations for improved simulation of intracranial aneurysm clipping

“…Because of the severe consequences of a rupture, the risks of not treating the aneurysms have to be weighted against the risks of treatment [4]. Aneurysms can either be treated minimally invasively or via surgical clipping [43]. During the clipping procedure, first a craniotomy is performed [17].…”

Microcatheter branch protection technique for coil embolization of wide-necked ruptured internal carotid artery aneurysm

“…Aneurysmal subarachnoid haemorrhage remains an important cause of stroke mortality and morbidity 1 . With the advancement of endovascular treatment, 2 increasingly more ruptured intracranial aneurysms are being treated with endovascular embolization. However, normal branches arising from the aneurysm wall are a limitation for endovascular technique.…”