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Intracranial aneurysms: two options are better than only one

Arquivos de Neuro-Psiquiatria
Publication Date
  • Medicine


681 Arq Neuropsiquiatr 2010;68(5):681-682 Editorial Intracranial aneurysms Two options are better than only one Paulo Puglia Jr.1 Correspondence Paulo Puglia Jr. Rua Inácio Pereira da Rocha 486 05432-011 São Paulo SP - Brasil E-mail: [email protected] AnEurismAs intrACrAniAnos: duAs opçõEs são mElhorEs quE umA 1MD, PhD. Department of Radiology, University of São Paulo Medical School, São Paulo SP, Brazil. In this issue, Arquivos de Neuro- Psiquiatria publishes three articles con- cerning the therapeutics of intracranial aneurysms (IA). These papers have many positive aspects, especially because they bring the debate on this topic to an im- portant journal that is read by many neu- rologists and neurosurgeons. Although they are very different, our position on the long path towards definitive answers may be shown by highlighting their cen- tral questions. Permeating the three articles is the fact that there are currently two different treat- ments for intracranial aneurysms: micro- surgical clipping (MC) and endovascu- lar coiling (EC). Since EC was introduced more recently, it is natural that it has to be proven to be at least as efficient and safe as MC, for it to be accepted. However, if the first treatment that existed was perfect, would anybody look for another one? When it was first intro- duced, EC was applied only to patients who were considered unfit for open sur- gery. This made it possible to offer some form of treatment for patients without any other option. The results were fair- ly good, and after years of improvements and research, EC became an option even for treating aneurysms that could be re- solved by means of MC1,2. Advantages for both types of treatment have been dem- onstrated, and great controversy persists with regard to choosing between them for a particular case. In general terms, EC is preferred for aneurysms located in poor- ly accessible sites, for ruptured aneurysms with severe clinical and neurological con- ditions an

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