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 flow-diverting 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. © 2011 The Authors. Surgical Practice © 2011 College of Surgeons of Hong Kong.