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Craniotomy and clipping have been the gold standard for treatment of aneurysmal subarachnoid hemorrhage (SAH). From my personal experience, all-over surgical results from craniotomy have not improved, even though surgical skills have improved greatly. Fifteen years has past since endovascular coil embolization became another option. From the result of ISAT, the endovascular coiling appeared to be a robust surgical technique. We are convinced that surgical clipping and endovascular coiling will play a complementary role in the treatment for aneurysm SAH and will improve patients' outcome. Given that younger neurosurgeons experience fewer cases of craniotomy and clipping surgery, a training system is essential to pass on clipping surgery skills. Each particular patient suffers problems that may worsen their outcome such as preoperative cardiopulmonary problems, delayed vasospasm, and high age. Careful management suitable to the condition of each patient will be necessary to produce a satisfactory outcome.
