Cerebral aneurysms: Clipping or coiling?

The goal of all therapeutic approaches to intracranial aneurysms is elimination of the sac from the circulation and prevention of a bleeding or rebleeding. Up to now neurosurgical clipping is the therapeutic gold standard. However, specifically for hind brain circulation aneurysms endovascular therapy using electrolytically detachable coils is increasingly used. The same is true for elderly patients and those with a bad clinical condition, if the anatomical configuration of the aneurysm is suited for GDC therapy in the anterior circulation. Procedural morbidity and mortality is lower in endovascular therapy: on the other hand, recanalization rates and the risk of re-bleeding is higher. However, it is still not evidence-based that this difference has any impact on clinical outcome after SAH. The decision between coiling and clipping has to made based on the individual patient, but should always be the result of an intensive discussion between the neurosurgeon and the neuroradiologist.