Endovascular therapy of intracranial aneurysms

Intracranial aneurysms are the major source of spontaneous subarachnoid hemorrhage. A mandatory indication for therapy is the acute rupture of an intracranial aneurysm to prevent often fatal early rebleeding. Incidental aneurysms also bear the danger of future rupture and treatment may be indicated. In the majority of cases, an endovascular treatment with detachable platinium coils is possible. With additional devices, complex wide neck aneurysms can be treated with endovascular techniques as well. Randomized studies revealed significantly less morbidity and mortality for the endovascular therapy compared to surgical clipping. Thus, the endovascular approach is the treatment modality of choice nowadays. Also, the long-term results favor the endovascular coilembolization of intracranial aneurysms. However, some aneurysmal configurations, in particular with branches arising from the aneurysmal lumen, are still reserved for neurosurgical therapy. In consequence, therapy and treatment of intracranial aneurysms should be performed from neurosurgeons, neurologists, and interventional neuroradiologists on an interdisciplinary consensus basis.