What are the treatment options?
After the diagnosis of an intracranial aneurysm, treat-ment is either by craniotomy or by endovascular therapy. After angiography, endovascular treatment most often consists of packing the aneurysm with detachable coils. In many centers endovascular embolization is the preferred treatment. The most common complication of endovascu-lar treatment is ischemic injury. The second most common complication is vascular perforation. Aneurysms without a sufficiently narrow neck cannot be treated successfully by endovascular embolization. In some cases, a stent is ini-tially placed in the artery whose lumen feeds the aneurysm. Thereafter, coils are introduced across the stent wall into the aneurysm cavity.
Classical treatment consists of craniotomy and clipping of the aneurysm. Most centers attempt early clipping following subarachnoid hemorrhage to prevent re-bleeding and permit safe induction of hypertension and hypervolemia as treatment of vasospasm. The worst time for craniotomy is considered to be at 7–10 days post-rupture, when the risk of ischemic vasospasm is greatest.