La neurochirurgie vasculaire. Evolution du traitement des anévrysmes intracrâniens

The treatment of cerebral aneurysms has evolved considerably for 50 years. Microsurgical techniques with the introduction of the microscope were the gold standart in the seventies and prestigious neurosurgeons have considerably improved the results of this challenging surgery mainly in the context of cerebro- and sub arachnoid hemorrhages. As endovascular techniques emerged in the nineties and considerably improved over time, it was thought that vascular microsurgery will progressively disappear. Conversely, microsurgical techniques have also evolved and neurosurgery continues to play an important role in the treatment of cerebral aneurysms. More recent advances in microsurgical treatment of aneurysms include microsurgical adjuncts, such as indocyanine green angiography, the exoscope, and novel bypass techniques for complex aneurysms. Endovascular techniques and modern vascular neurosurgery are therefore complementary tools and need experts in both fields for the best management of this challenging pathology.