Modern aneurysm surgery: a pro-open surgery view

Modern management of intracranial aneurysms is matter of great debate between supporters of “traditional” microsurgical treatment and those of relatively new endovascular management. This paper briefly reports the experience of two experienced microvascular “traditional” neurosurgeons who shares the same management philosophy favouring open microsurgery in the modern era in which endovascular management is becoming fashionable. Difficult posterior circulation aneurysms are nowadays as a rule managed endovascularly, whilst anterior circulation aneurysms can be treated with both techniques, and MCA as well as distal ACA aneurysms are better treated microsurgically. Technical refinement and — hopefully- lower cost of endovascular devices will favour a trend of prevailing use of endovascular method in the future. However the need for well-prepared microvascular surgeon will always be there, and proper training of future generations of microvascular surgeons in a setting of decreasing number of patients and open surgical casuistics represents a big challenge for the neurosurgical community, to which an answer should be given.