Endovascular management of intracranial aneurysms has made considerable progress since coils were the only available tech­nology [18]. The times of microsurgical clipping versus coiling are essentially gone as technology evolved and the eld matured with the acceptance of endovascular neurosurgery within its practice. Intracranial laser-cut stents were developed to provide the ability to safely treat wide-necked aneurysms without the risk of coil prolapse [19]. Although the earlier generation of these devices had limitations, such as kinking or fracture in sharp curvatures, the most recent laser-cut and braided micro­stents have mostly overcome these issues [20]. Perhaps the most remarkable evolution of endovascular neurosurgery within the last decades was the advent of ow diverters. These devices have shifted the landscape of internal carotid artery aneurysm treatment toward endovascular management [21]. Aneurysms of the posterior circulation have presented more challenges, but ow diversion is slowly becoming the mainstay of treatment at this location as well [22]. Furthermore, industries are exploring surface-modication and bioabsorbable technologies to reduce the need for antiplatelet therapy and diminish the thrombogenic potential of these devices, which may improve the quality of life of patients with unruptured aneurysms treated with these devices and even unlock many possibilities in the treatment of ruptured aneurysms with complex morphologies [23, 24]. The most recent class of intracranial devices are the intrasaccular ow dis­ruptors, such as the Woven EndoBridge device (Terumo), which can potentially eliminate the need for antiplatelet therapy and have promising applications in the setting of subarachnoid hem­orrhage (SAH) [25]. Similarly, temporary expandable neck­bridging stents, such as the Comaneci (Rapid Medical), have provided the option of assisting coil packing of ruptured aneu­rysms without the need to permanently deploy a stent in the par­ent vessel (thereby eliminating the need for antiplatelet therapy) or occlude the parent vessel lumen (such as during balloon­assisted coiling) [26].

patients in which 50 CSFVFs were embolized, with improvement of clinical symptoms and magnetic resonance imaging (MRI) nd­ings (e.g., brain sagging, pachymeningeal enhancement) experi­enced by 90% of the patients [44]. The most common postprocedural

nding was pain localized to the injection site, which tended to improve over a few weeks without the need of medication in 30% of the patients. Interestingly, “rebound” intracranial hypertension was seen in 17.5% of patients. This nding raised discussion by the authors regarding a possible relationship between intracranial hypotension and undiagnosed idiopathic intracranial hypotension [44]. Although CSFVF embolization appears to be the most effec- tive and safe minimally invasive treatment for intracranial hypo­tension so far, future larger series will determine whether this therapy will become a mainstay of management.

Therefore, VSS has led to some additional clarity of the incit­ing and persistent mechanisms of IIH.It is expected that newer stents optimized for this use will become available in the near future, and treatment indications with more solid recommenda­tions will be delineated.

In addition to recent advancements in the treatment of IIH and venous pathologies of the brain, there are exciting new technolo­gies under development to address hydrocephalus through endo­vascular means. One such technological innovation is the eShunt System (CereVasc, LLC), which is an endovascular transluminal catheter-deployed shunt designed to be implanted into the inferior petrosal sinus [62]. This biomimetic transluminal shunt is designed to serve in an analogous function to the arachnoid gran­ulations of the brain, providing a direct CSF-to-venous outow tract without the intervening need for a subcutaneous catheter or an implantable mechanical valve [62]. Surgically implanted ven­tricular CSF shunts are often plagued by mechanical issues or infection, especially in the immediate postimplantation period, requiring revision surgery. Ventricular shunts have been found to have a 15–25% 30-day failure rate, with 1-year failure rates of up to 28% [63, 64]. This high rate of failure is associated with vastly increased costs of care and contributes to a cumulative yearly cost of more than $1 billion in the USA alone [65]. The need for repeat revisions, extended hospital stays, and potential life-threatening consequences of shunt failure is burdensome to patients, their families, providers, and the hospital system. A meaningful, mini-