Historical Perspective and the Role of Endoscopy in Intracranial Aneurysm Surgery

Abstract

The surgical treatment of cerebral aneurysms has a relatively recent history, dating to the 1930s, and it is still an evolving field. In 1931, Norman Dott performed the first direct treatment of a ruptured intracranial aneurysm successfully packing the aneurysm and internal carotid artery (ICA) with muscle. Dott was also credited with introducing cervical carotid ligation for the treatment of ruptured intracranial aneurysms in 1933. The first successful description of an intracranial aneurysm clipping was in 1937, when Walter Dandy used a silver clip to treat a ruptured ICA aneurysm. Dutton and Selverstone introduced wrapping as a routine method for treating intracranial aneurysms that were difficult or impossible to clip. Suboptimal results in the 1950s led to the reappraisal of the indirect method, which was first described by Dott. Valentine Logue was responsible for its popularization advocating the proximal ligation of the dominant anterior cerebral artery in patients with ruptured anterior communicating aneurysms. Despite the technical advances, the morbidity resulting from direct treatment of intracranial aneurysms was still substantial. The introduction of the microscope to neurosurgery in the 1960s had a tremendous impact on the results of aneurysm surgery. In addition to improving the results of aneurysm surgery by experienced surgeons, the microscope accelerated the learning curve of young neurosurgeons who applied themselves to learning and