Role of surgical treatment of intracranial aneurysms in the era of endovascular therapy: a review.

The goal of intracranial aneurysm treatment is to exclude the lesion from the circulation while preserving the parent vessel and function in the neural tissues. Endovascular treatment (EVT) has been continually evolving with newer technological innovations, and with the advent of novel devices such as flow diverters and endosaccular flow disruption devices, has altered treatment decision-making for clinicians. Despite these advances, microsurgery continues to play an important role in the treatment of cerebral aneurysms. In general, while endovascular coiling and microsurgical clipping appear to yield similar long-term functional outcomes, the reduced procedure-related and short-term morbidity achieved with EVT comes with an increased rate of residual or recurrent disease and need for retreatment. This review provides practicing neurosurgeons with a summary of the various surgical techniques and adjuncts, an analysis of the available clinical data, and assistance in individualized decision-making by analyzing ideal or less-than-ideal scenarios for a given technique.