Evolution of intracranial aneurysm treatment: From Hunterian ligation to the flow diverter


  • Conflict of interest or financial disclosure: none.

  • This paper was presented at the 1st AMM-AMS-HKAM Tripartite Congress on 14th November 2010.

Email: georgewong@surgery.cuhk.edu.hk


Background:  Intracranial aneurysm rupture has the highest levels of mortality and morbidity among all stroke types. To answer the question of how and why different well-established and novel treatment techniques were developed, it is crucial to understand the historic hurdles and breakthroughs in intracranial aneurysm treatment over the years.

Methods:  Literature review was carried out using PubMed and the electronic database of Surgical Practice. Relevant articles were retrieved for further appraisal.

Results:  The neuro-endovascular treatment field has evolved from the use of detachable balloons or coils to the use of bioactive coils, balloon test occlusion, the balloon- and stent-assisted techniques, and the flow-diverting stent. The application of intraoperative indocyanine green angiography has also improved microsurgical treatment in recent years.

Conclusions:  Advances in endovascular technology have made coiling the cornerstone of intracranial aneurysm treatment. However, the roles played by different endovascular tools need to be better understood.