This introductory chapter provides the readers with an insight into the history
of neuroendovascular surgery. Acknowledging the past is of the utmost importance to
understanding and interpreting present dynamics and future directions in such a young,
yet quickly evolving medical field. Starting from ancient history with the first
descriptions of cerebral aneurysms, we describe the era of the extravascular approach to
cerebrovascular disease with a focus on the main techniques conceived such as arterial
ligation, aneurysm wrapping, trapping and packing. With the invention of the
aneurysmal clip, the direct surgical approach to cerebral aneurysms gained a privileged
place in the management of intracranial vascular disease which it retained throughout
most of the second half of the 20th century. Nevertheless, marked by the invention of
cerebral angiography, the endovascular era symbolically began in 1927. Ingenious,
sometimes bizarre and hazardous, endovascular approaches to cerebrovascular disease
are recounted, touching the history of the evolution of endovascular techniques, embolic
materials and navigation devices. Modern neuroendovascular surgery is described with
a focus on the development of coil technology which represents an essential milestone
as it gave a massive impulse toward the birth of a new subspecialty in neurosurgery. At
the end of the chapter we discuss how the training of young neurosurgeons is changing
and should cope with these new acquisitions. The role of neuroendovascular surgery in
neurosurgical residency programs is summarized for the United States, Japan and
Europe. Should this be part of the neurosurgeon’s armamentarium? Could it be
delegated completely to the neurointerventional radiologist or might it be best part of a
completely new specialty?
Keywords: Cerebrovascular disease, history, interventional, neuroradiology,
stroke, subarachnoid hemorrhage.
