Intracranial aneurysms and selected vascular lesions represent abnormalities of cerebral blood vessels that pose a risk of hemorrhage, neurological injury, and death. Aneurysms result from focal weakening of arterial walls, while other vascular lesions include arteriovenous malformations and cavernous malformations. Neurosurgical management is guided by lesion characteristics, rupture risk, and patient-specific factors.

Patients may present incidentally, with symptoms related to mass effect, or following hemorrhage. Ruptured aneurysms typically cause subarachnoid hemorrhage with sudden severe headache, altered consciousness, and neurological deficits. Unruptured lesions may be asymptomatic or cause cranial nerve compression or seizures.

Neurosurgical evaluation includes detailed imaging to assess lesion morphology, size, neck configuration, and relationship to surrounding structures. Treatment decisions weigh rupture risk against procedural risk. Selected lesions are best managed surgically based on anatomical considerations and clinical context.

Surgical objectives include definitive exclusion of the lesion from the circulation while preserving normal blood flow. Microsurgical techniques are employed with intraoperative visualization and neurophysiological monitoring. Postoperative care focuses on prevention of vasospasm, hydrocephalus, and secondary complications.

Long-term follow-up is essential to monitor for recurrence or progression and manage neurological sequelae. Selected aneurysm and vascular lesion surgery requires specialized neurosurgical expertise and careful patient selection.