Certain neurovascular lesions like complex aneurysms are difficult to treat using conventional neurosurgical techniques due to their size, vascular connections, morphology, or inaccessible location. In these cases, the ability to stop or reduce blood flow through the parent artery allows for reduction of intralesional turgor and subsequent clipping or excision. With recent advances in interventional neuroradiological technology, many of these complex lesions are detected earlier and treated endovascularly. As a result, the use of flow arrest–assisted neurosurgery to treat complex lesions like aneurysms has declined significantly in the past decade. There are institutional and personal variations to anesthestic techniques, with no clear evidence supporting any particular protocol or technique. In this chapter, we present our opinion on techniques and solutions to commonly encountered problems.
