Conclusion

aSAH remains a devastating problem, with high morbidity and mortality. Improvements in CTA and MRA have aided in the detection of aneurysms and have facilitated planning for intervention. Although their sensitivity and accuracy of detecting aneurysms (which have improved during the past decade) exceed 90%, the IA digital subtraction angiogram remains the gold standard for diagnosing aneurysms. Currently, aneurysm treatment should ideally be referred to specialized centers of excellence that have subspecialists in both cerebrovascular neurosurgery and endovas-cular interventional neuroradiology who perform a high volume of cases. The deciding factor for a good outcome is not necessarily the type of intervention, but the volume of procedures that have been performed at a particular center; center expertise can reduce mortality by 43% (33).

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