{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:53:48Z","timestamp":1785434028499,"version":"3.56.0"},"reference-count":60,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"abstract":"<jats:title>ABSTRACT:<\/jats:title>\n                  <jats:p>Microsurgical treatment of complex cerebral aneurysms \u2013 whether giant aneurysms or those in the technically challenging posterior circulation \u2013 carries substantial perioperative morbidity and mortality. Despite significant advances in endovascular therapy, surgical intervention remains the only definitive option for a subset of these lesions. To facilitate dissection and reduce tension within the aneurysm sac, various aneurysm flow arrest strategies have been developed. Early methods included local arrest (e.g., temporary clipping) and systemic arrest (e.g., adenosine-induced asystole, rapid ventricular pacing or total circulatory arrest). These have evolved into more targeted cerebral flow arrest techniques, such as retrograde suction decompression, providing greater precision and control. Because aneurysm flow arrest inherently risks distal cerebral ischemia, hypothermic neuroprotection was introduced to prolong the safe ischemic interval \u2013 transitioning from early high-morbidity systemic deep hypothermia to recent selective brain cooling with more favorable outcomes. The integration of multimodal intraoperative neuromonitoring, including evoked potential monitoring and respiratory rate monitoring, for real-time cerebral ischemia detection, has further improved safety. Together, controlled aneurysm flow arrest and selective brain protection with intraoperative neuromonitoring create brief, precisely timed windows that permit safe aneurysm manipulation and definitive treatment of high-risk lesions. As such complex cases are less commonly treated surgically, much of the specialized knowledge is passed informally. This article reviews the anesthetic considerations for the surgical management of giant and posterior circulation aneurysms, drawing on decades of our institutional experience.<\/jats:p>","DOI":"10.1017\/cjn.2026.10594","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T10:15:03Z","timestamp":1774520103000},"page":"1-12","source":"Crossref","is-referenced-by-count":0,"title":["Anesthetic Considerations for Surgical Treatment of Giant and Posterior Circulation Cerebral Aneurysms"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8415-6149","authenticated-orcid":false,"given":"Jason","family":"Chui","sequence":"first","affiliation":[{"name":"Vancouver General Hospital and University of British Columbia"},{"id":[{"id":"https:\/\/ror.org\/02grkyz14","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Western Ontario and London Health Science 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