Westchester Neurovascular Symposium: Advances in Stroke Care. Westchester Medical Center, Valhalla, NY, November 15, 2019. Guest Editors: Justin Santarelli MD and Ramandeep Sahni MDMicrosurgical Clipping of Intracranial Aneurysms in the Endovascular EraHarker, Pablo MD*; Vranic, Justin MD†; Patel, Aman B. MD*Author Information From the * Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA †Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Disclosure: Dr A.B.P. is a consultant for Penumbra, Microvention and Medtronic. The other authors declare no conflict of interest. Correspondence: Aman B. Patel, MD, Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White 5-502, Boston, MA 02114. E-mail: [email protected] Cardiology in Review: January/February 2021 - Volume 29 - Issue 1 - p 15-19 doi: 10.1097/CRD.0000000000000343 Buy Metrics Abstract The treatment of intracranial aneurysms (IA) began in the late 19th century. Some degree of controversy has always surrounded the best treatment modality for IA. Cushing and Dandy debated about cervical carotid ligation as the only surgical alternative before the introduction of microsurgical clipping. In the early 21st century, the debate has centered on surgical versus^ endovascular techniques. With the advent of newer endovascular techniques and devices, there has been a dramatic shift in treatment paradigms toward endovascular intervention that is preferred by both physicians and patients. However, there will always be a need for microsurgical cerebrovascular expertise since some aneurysms cannot or should not be embolized. This creates a difficult conundrum as only the most complex of aneurysms will require open surgery, but the lack of volume and training will be a challenge in teaching and maintaining the surgical expertise required to safely treat them. The purpose of this review is to discuss the history of IA treatment and critically evaluate the current state of the art of IA treatment, with a specific focus on the necessary role microsurgical clipping continues to play in the current treatment landscape. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.