Brain protection for cerebral aneurysm surgery

The modern management of patients undergoing surgery for intracranial aneurysm often includes temporary periods of cerebral ischemia to minimize the risks final dissection and clipping or to allow vascular reconstruction. This article reviews the concepts of ischemic thresholds and examines the effects of the physiologic variables that may affect outcome from an ischemic episode. The protective agents presently available and the agents in development that may limit the extent of ischemic injury are reviewed extensively as well.