Direct aneurysm surgery in the multimodal treatment era

Recent technical advances in endovascular therapy for the treatment of cerebral aneurysms have led to comparisons of its benefits with those of direct microsurgical repair. The criteria for selecting an optimal approach for individual patients vary across both practitioners and institutions. Therefore, we reviewed the records of 1,977 consecutive patients, treated between 2012 and 2017 at our facility, to evaluate current aneurysm treatment strategies and their results. During the study period, of the 1,977 patients, 1,026 (51.9％) underwent microsurgical repair. Over time, the number of patients undergoing microsurgery did not decrease, but the proportion of complex aneurysms increased in the microsurgical group. Presently, patients with wide‒based, irregular‒shaped small aneurysms；partially thrombosed aneurysms； large/giant aneurysms；and blood blister‒like aneurysms predominantly undergo microsurgery at our institution. Microsurgery continues to be a principal primary treatment modality for complex lesions or as salvage treatment after endovascular treatment. Therefore, advanced training opportunities are necessary to improve the skills of cerebrovascular surgeons.