Summary
Intracranial aneurysms and the results of rupture of such treacherous lesions, i.e., subarachnoid hemorrhage (SAH), were first recognized in the early 19th century. With the introduction of cerebral arteriography in 1927 by Egas Moniz and Almeida Lima the stage was set for consideration of surgical obliteration of intracranial aneurysms. Epidemiological studies have shown varying incidence rates of aneurysmal SAH from one geographical area to another. Interestingly, aneurysmal SAH seems to be very rare amongst nomadic bedouins whereas the incidence of this dreadful condition is high or > 20/100.000/year among their “opposite”, the nomadic Laplandish ethnic group of the Ural-Altaic family. Attempts to approach ruptured intracranial aneurysms in the anterior circulation were made by several pioneers in the 1930s to 1960s but turned out most hazardous and many a pioneer neurosurgeon experienced more of operative disasters than of successful surgery. It was learnt that by delaying surgery the operative outcome could be improved but in the waiting period many patients died or became disabled due to early rebleeds and/or SAH-induced cerebral ischemic deterioration of delayed onset. Visualization of cerebral anteriovenous malformations, AVMs, was greatly improved by Lysholm and consequently surgical treatment of AVMs was first developed by Olivecrona, who in 1936 reported four successful resections of cerebral AVMs; as of May 1948 his operative mortality was below 10%. With the introduction of the counterbalanced operating microscope, a wide range of microsurgical instruments for cerebrovascular surgery, improved neuroanaesthesia, and concentration of such demanding cases — as those with a cerebral AVM or a ruptured intracranial aneurysm — to specially geared major referral centres with an accumulated experience and organization to handle such cases, operative results have improved considerably. In parallel, timing of the surgical intervention has swung in favour of attempts to perform surgery as soon as possible. In the last decade endovascular coil occlusion of ruptured aneurysms has evolved rapidly and may with future improvements become the method of choice instead of open surgery with ‘external’ clipping of the ruptured sac. Endovascular embolization techniques and radiosurgery represent recent advances in the treatment of cerebral AVMs although direct surgical excision is still recommended for most cases. The evolution of surgery for aneurysms and AVMs are depicted chronologically with emphasis on some historical landmarks.
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Ljunggren, B., Sharma, S., Fodstad, H. (1994). History and Epidemiology of SAH and Cerebrovascular Malformations. In: Pasqualin, A., Da Pian, R. (eds) New Trends in Management of Cerebro-Vascular Malformations. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9330-3_1
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