Open Surgery First Strategy for Ruptured Cerebral Aneurysms in the Current Neurosurgical Circumstance

Abstract

  Prevention of rebleeding is extremely important for ruptured cerebral aneurysms, and either open surgery or endovascular treatment is recommended as a prophylactic measure. The decision on which treatment strategy to use is based on a comprehensive evaluation of the patient's clinical and cerebral aneurysm findings from both methods.

  Surgical clipping is selected in cases wherein the advantages of open surgery can be utilized and disadvantages of endovascular coiling can be compensated. The advantages of surgical clipping include the ability to control intracranial pressure and perform revascularization, while the disadvantages of endovascular coiling include microaneurysms, large aneurysms, and aneurysms that require stents.

  The surgeon should be familiar with surgical clipping and endovascular treatment and should aim to deepen the understanding of the pathophysiology of ruptured cerebral aneurysms to provide the best treatment for each case.