To treat aneurysms, two therapy options are available: surgical clipping (craniotomy) or coiling (endovascular treatment). ■Surgical Clipping Surgical clipping is a radical cure for aneurysm. Before the surgery, a 3-dimensional scan is used to diagnose the aneurysm and simulate what the aneurysm will look like with the planned craniotomy range, and whether the surrounding blood vessels will interfere with the clipping. In general, craniotomy is performed from the shortest distance to the aneurysm. Without making any incision into the brain, the aneurysm is exposed using the space around the brain. After securing the surrounding blood vessels, a clip is placed in the “neck” (narrow part) of the cerebral aneurysm to complete the surgery. Cerebral Aneurysm Before the clipping After the clipping ■Endovascular Treatment Treatment for cerebral aneurysm/cerebral arteriovenous malformation, by inserting a catheter through a pinhole in the artery of the thigh or wrist. An extremely thin catheter is placed inside the aneurysm, and platinum coils are packed inside. ■Gamma Knife Surgery This procedure is preformed to treat cerebral arteriovenous malformation. If the lesion is small, it can disappear in several years, but there are cases where combining with endovascular treatment and/or surgical therapy must also be considered. Cerebral Arteriovenous Malformation At the time of gamma knife procedure Three years post-treatment Physicians on staff Hisao Hirai, M.D., Ph.D. １９９１ Department of Neurosurgery, Shiga University of Medical Science １９９２ Department of Neurosurgery, Nagahama Red Cross Hospital １９９５ Department of Neurosurgery, Rakusai Shimizu Hospital １９９９ Department of Neurosurgery, Hino Kinen Hospital ２００１ Department of Neurosurgery, Kotoh Kinen Hospital ２００４ Trained at Kalorinska University (Sweden) Takuro Inoue, M.D., Ph.D. １９９１ Department of Neurosurgery, Shiga University of Medical Science １９９２ Department of Neurosurgery, Osaka Prefecture Saiseikai Hospital １９９４ Department of Neurosurgery, Daini Okamoto General Hospital １９９８ Studied at University of British Columbia (Canada) １９９９ Department of Neurosurgery, Hino Kinen Hospital ２００４ Trained at Kalorinska University (Sweden) ２００７ Trained at Duke University (U.S.A.) ２０１１ Department of Neurosurgery, Kotoh Kinen Hospital ２０１５ Consultant, Department of Neurosurgery, Andalusia Hospital (Alexandria, Egypt) ▲UP

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