Conventional microsurgical technique and endovascular method for the treatment of cerebral aneurysms: a comparative view

Abstract

Endovascular embolization using Guglielmi Detachable Coils (GDCs) for complicated intracranial aneurysms has become widely accepted as an alternative to direct surgery. There is now a choice of therapeutic options for the management of cerebral aneurysms. The decision for treatment of an individual patient should be based on objective selection of the safest and most effective treatment. In addition, less invasive and cost effective treatment should be chosen. 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. GDC embolization is a less invasive and safe treatment with low incidence of periprocedural morbidity, and has been successful in preventing acute subsequent bleeding, whereas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. High incidence of recanalization was promoted in cases with neck remnant and/or body filling. In contrast, the most important advantage of direct surgery is long-term durability, while conditions of patients and aneurysmal geometry limit the indication of direct surgery. In addition, direct surgery could be applied to complicated aneurysms with wide-neck or branching from the neck in combination with vascular reconstruction technique, such as EC-IC bypass. With these limitations in mind, patients need to be very carefully chosen for GDC embolization or direct surgery.