Drake C G
Can J Surg. 1984 Nov;27(6):549-55.
In the late 19th and first half of the 20th centuries, intracranial aneurysms were seldom treated and when they were, Hunterian occlusion of the carotid artery was almost always performed. Although a few pioneer intracranial procedures were done in the 1930s, it was not until after World War II that a major effort was made to obliterate aneurysms during craniotomy. Rebleeding before operation and ischemia with vasospasm were the chief causes of the high morbidity associated with early surgical attempts and even now they remain a problem. However, since the operating microscope was introduced and with modern neuro-anesthesia, intracranial surgery has become routine and reasonably safe, especially since simple modification of the ischemic syndrome by volume expansion and hypertension has proved effective. A return to early operation is now under evaluation. Treatment of aneurysms on the basilar circulation came later and experience in dealing with giant aneurysms on both the carotid and basilar systems is now accumulating.
在19世纪末和20世纪上半叶，颅内动脉瘤很少得到治疗，即便进行治疗，几乎总是采用亨特氏颈动脉闭塞术。尽管在20世纪30年代做了一些开拓性的颅内手术，但直到第二次世界大战之后，才在开颅手术期间大力致力于消除动脉瘤。手术前再出血以及伴有血管痉挛的缺血是早期手术尝试相关高发病率的主要原因，即使到现在它们仍然是个问题。然而，自从引入手术显微镜并采用现代神经麻醉以来，颅内手术已变得常规化且相当安全，特别是因为通过扩容和高血压对缺血综合征进行简单改良已证明是有效的。现在正在评估是否回归早期手术。基底循环动脉瘤的治疗出现得较晚，目前关于颈动脉和基底系统巨大动脉瘤的治疗经验正在不断积累。
