Increasing success in the surgical treatment of certain kinds of cerebrovascular accidents can be attributed to improved techniques in anesthesiology, intracranial and extracranial vascular surgery, and diagnostic measures such as cerebral angiography.
Cerebral angiography has indicated for example that occlusive disease of extracranial arteries is frequently a cause of progressive, intermittent, or apoplectic symptoms and signs suggestive of intracranial vascular pathology. This alone is an important contribution, for partial occlusion of an extracranial vessel such as the internal carotid artery can usually be treated effectively by endarterectomy.1 Technical developments in small vessel surgery, moreover, suggest that similar methods of treatment for partly occluded intracranial arteries may ultimately be possible as well as intracranial hemorrhagic crises.
With respect to subarachnoid hemorrhage, it has become increasingly clear that rupture of an intracranial aneurysm must always be considered. In younger individuals an arteriovenous malformation, angioma, or brain tumor must also be thought