Neurosurgery for Cerebral Aneurysms

Abstract

The goal of cerebral aneurysm surgery is to prevent rupture or further enlargement of the aneurysm while at the same time preserving all normal vessels and minimizing injury to brain tissue and cranial nerves. This is usually accomplished by excluding the aneurysm from the circulation with a clip across the neck. Compared to coiling, the advantages of clipping are a higher rate of aneurysm obliteration, superior protection from rebleeding, as well as less need for follow-up and re-treatment due to a higher durability of clipping. In view of the higher morbidity associated with surgery itself, the principal challenge in aneurysm surgery is to clip the neck adequately without neck remnants and with minimum injury to the brain while preserving flow within the parent artery and avoiding obstruction of branching perforators. This chapter provides an overview of surgical considerations and operative techniques for microsurgical management of cerebral aneurysms at their most frequent localizations.