Future potential and challenges of aneurysm surgery

Cerebral aneurysm surgery became well‒established after the introduction and widespread use of the surgical microscope, endoscopy, and monitoring techniques. However, recent advancements in endovascular techniques have changed the treatment environment. In the past, superiority or inferiority of surgery compared to endovascular treatment was the main issue in determining management strategies for cerebral aneurysms, as shown by the International Subarachnoid Aneurysm Trial or the Barrow Ruptured Aneurysm Trial. Today, however, this competition is transforming into a more collaborative relationship as hybrid surgeons who are familiar with both open surgery and endovascular treatment are increasing in number. It will be crucial to individualize the treatment strategy for each aneurysm patient using modern imaging techniques, computational flow dynamics, and molecular biology.