Changes and innovations for the surgical management of intracranial aneurysms

Advancements have been made in the understanding of intracranial aneurysms and their management. Surgical strategies have evolved, with many principles revisited, many approaches reconsidered, and many frontiers successfully conquered. The global expansion of endovascular services has challenged the existence of aneurysm surgery, changing the complexity of aneurysm case mix and volume that are presently referred for surgical repair. As in the evolution of any type of procedures, innovations arise from the criticisms of currently available techniques. The development and technological maturation of endoscopic surgery in recent years have emboldened neurosurgeons, who are already familiar with the transsphenoidal techniques, to consider expanded endonasal approaches for the treatment of more complex cranial base pathologies. The surgical relevance of an endoscopic transnasal access for the clip reconstruction of intracranial aneurysms is a natural extension of the philosophy underlying this evolution. This thesis presents a compilation of scientific investigations (through literature reviews, clinical studies and preclinical experiments) that examined the history, evolution and contemporary innovations in the surgical management of intracranial aneurysms. The results of this study have the potential to expand the therapeutic options for intracranial aneuryms.