Microsurgery / Endovascular / Combined Treatment of Intracranial Vascular Lesions

Abstract

Introduction: Intracranial vascular lesions treatment includes, nowadays, several options, and requires careful evaluation when deciding which modality to choose. The goals remain simple - permanent occlusion and optimal preservation or even restoration of patient’s neurological function. There are two main groups of treatment, microsurgery and endovascular. With development of multidisciplinary approach there are cases that require, and are eligible for combined treatment. Varieties of factors have to be considered when deciding on treatment modality. Those include whether vascular lesion has ruptured or not, it’s size and location, patient’s age and medical condition and associated factors such as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) or presence of vasospasm. Aim: We present several cases treated microsurgical, endovascular or with combined approach considering latest recommendations, multidisciplinary decisions making (neurologist, radiologist, neurosurgeon) and availability of an interventional option that had an acceptable risk. Material and Methods: The cases have been chosen regarding the presentation, treatment option and outcome. Results: On the basis on several cases presented, we have considered indications and so far published several studies results and recommendations regarding treatment options for intracranial vascular lesions, focusing on combined approach. Conclusion: With development of endovascular treatment techniques, which are approaching the phase of acceptance and appropriate use, the patients with intracranial vascular lesions have gained a therapy option that can be primary, secondary or combined with surgical treatment. The decision on treatment option has to be individually based considering patient/lesion factors and institutional availability of each technique experts.