As the saying goes, “It is difficult to make predictions, especially about the future.” While the past is not necessarily a clear guide for our future, over the past 90 years, dramatic progress has been made in the field of cerebrovascular neurosurgery. Walter E. Dandy, MD, reported the first case of clipping of an aneurysm in 1936, and this technique was a mainstay of treatment of aneurysms for decades until recently. Although the general idea remained the same for the subsequent 50 years, consider the following major advances over the last 30 years:
- Detachable coils reached clinical practice in the 1990s as a new treatment for cerebral aneurysms and other vascular disorders.
- Since then endovascular hybrid operating suites have proliferated, combining the advantages of open and endovascular techniques for cerebrovascular disorders.
- In the past several years, flow-diverting stents and other devices have come online, advancing endovascular techniques.
- In 2015, four endovascular stroke trials changed our treatment paradigm for patients with acute stroke. As a result, the indications for mechanical thrombectomy have expanded dramatically, and again the patient has benefitted from the ingenuity of cerebrovascular specialists.