We thank the authors for their interest in our article and the additional comments and insights provided. Minimally invasive approaches are certainly being favored over conventional approaches, which typically require larger exposures and may result in significant patient morbidity. These trends are seen in both cranial and spine surgery. Nonetheless, minimally invasive approaches are still plagued by numerous limitations that restrict their utility in the treatment of various pathologies. With respect to the endovascular treatment of intracranial aneurysms, coiling has consistently been shown to be associated with significantly higher rates of reoperation for both ruptured and unruptured aneurysms.1,2 Furthermore, endovascularly treated patients also have significantly higher rates of postoperative angiogram use than those whose aneurysms were clipped. Endovascular procedures are not benign; thus, coiled patients may be at a higher long-term risk of complications such as hemorrhage, stroke, or vascular injury. In addition, the higher rates of required procedures may consequently result in increased healthcare costs over the lifetime of the patient. However, we recognize the benefits provided by endovascular procedures and are confident that further innovations will increase their efficacy and cost-effectiveness. Of note, it is important to mention the rise in the number of endovascular training programs and trainees in the United States.3 As a result, many entering the field have been trained in programs with relatively low volume, resulting in less experienced providers. Because studies have shown worse outcomes for low-volume institutions and physicians, overall morbidity and mortality may increase or remain stable despite improvements in technology.4 Further studies that directly compare outcomes, retreatment rates, and costs for coiling and clipping at high-volume centers are needed to provide data reflecting the highest levels of expertise and care. The authors correctly note that health care is becoming increasingly consumer driven. Patients certainly do prefer the more minimally invasive option, primarily because of the cosmetic benefits and the perception of fewer complications with smaller approaches. Nonetheless, although patients have the right to and are encouraged to be involved in the decision-making process for disease treatment, physicians must use their expertise and experience to adequately counsel and guide patients. In the debate on coiling vs clipping, neurosurgeons should always offer the best treatment approach based on aneurysm anatomy, size, and location; circulation; and patient age and comorbidities, regardless of cost, insurance status, or cosmetic concerns. We should also openly discuss the likelihood of additional treatment when discussing the potential treatment choices, because of not only the additional procedural complication risks but also the healthcare charges that patients will inevitably accrue. Furthermore, in the current economic climate and with the changes in health care, procedures will undoubtedly be evaluated primarily by their safety and cost-effectiveness. In conclusion, we agree that patients are powerful driving forces that may significantly affect treatment choice for various disease processes. However, as neurosurgeons, we must not allow cosmesis alone to determine treatment choice for neurosurgical diseases because operative complications oftentimes may have devastating consequences. Furthermore, although consumers are one of the key stakeholders in healthcare decision making, current healthcare expenditures are not sustainable. An aging population, the improving economy, and the current US healthcare overhaul will push spending on medical services to almost 20% of the US gross domestic product by 2021. Studies that examine cost-effectiveness by providing the current clinical landscape and identifying current shortcomings will be critical. Future innovations will be driven by those interventions that demonstrate ethical, value-added innovation with superior outcomes at lower cost. We again would like to thank the authors for their comments and look forward to further discussion on the health economics and treatment of intracranial aneurysms and a variety of other neurosurgical conditions. Disclosure The authors have no financial or institutional interest in any of the drugs, materials, or devices described in this article.