Neurointerventional Surgery

A brain aneurysm is a weak spot of a blood vessel in the brain seen as an abnormal bulge. Brain aneurysms can leak or rupture, resulting in a brain bleed (hemorrhage) which can result in severe, permanent disability and/or death. A ruptured aneurysm is considered a life-threatening emergency and requires immediate medical attention and treatment. Symptoms include a sudden, severe headache, nausea and vomiting, neck pain, blurred vision or loss of consciousness.

Endovascular Embolization is a minimally invasive procedure to treat brain aneurysms. The Neurointerventional Surgeon feeds a soft, flexible tube called a catheter into the brain aneurysm via a small hole made in an artery in the groin. Embolization of the aneurysm is then accomplished by various techniques, including the placement of platinum coils inside the aneurysm, thereby blocking blood flow to the aneurysm, or placement of a flow diverting device (Pipeline Device) across the aneurysm in order to direct blood flow away from the aneurysm.

These techniques are performed under general anesthesia and take just a few hours.

Endovascular Embolization can be used to treat both ruptured and unruptured brain aneurysms. The decision to treat an unruptured brain aneurysm that is not causing symptoms is based on many factors, including the size, shape and location of the aneurysm, your overall health and your family history.

An arteriovenous malformation (AVM) is a tangle of blood vessels in the brain that bypasses normal brain tissue and diverts blood from the arteries to the veins. AVMs are extremely rare, affecting less than one percent of the population. Most are congenital (present at birth), but some form later in life. AVMs put pressure on the blood vessels and raise your risk of seizure or stroke.

AVMs can cause symptoms, such as seizure or stroke, or can be asymptomatic and only discovered during a brain scan for another health issue. Once diagnosed, the decision to treat an AVM is based on its size, location, your overall health and the risk of future complications if left untreated.

Endovascular Embolization is a minimally invasive procedure to treat an AVM. The Neurointerventional Surgeon feeds a soft, flexible catheter to the site of the AVM via a sheath inserted in an artery in the groin and injects a glue-like substance to block blood flow to the malformed vessel. Although in some cases Embolization can be a successful stand-alone treatment, Endovascular Embolization is often used in combination with surgical resection or radiation for the best result.

An arteriovenous fistula (AVF) is a tangle of blood vessels with abnormal arterial and venous connections, similar to an AVM. AVFs are more likely to develop later in life and are often found in the brain or spine. Like AVMs, they raise your risk of seizure and stroke.

Treatment depends on the fistula’s size, location and whether or not it is causing any other health problems. If the AVF is small, monitoring may be sufficient. If it is larger and potentially troublesome, your doctor may recommend Endovascular Embolization.

Carotid artery disease occurs when one or both of the carotid arteries in the neck become narrowed or blocked by plaque. The carotid arteries are two large blood vessels that supply blood to the brain. When they become obstructed, one is at increased risk of stroke.

Stroke is a medical emergency! Treatment is most effective when given within the first few hours, so it is important to recognize the symptoms and act quickly. If you suspect a stroke, call 911 immediately. EMS can begin vital treatment in the ambulance. Stroke symptoms include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Carotid Artery Stenting is a minimally invasive technique to treat severely narrowed or blocked carotid arteries. In this procedure, the Neurointerventional Surgeon inserts a catheter through the groin and threads it to the neck. A small balloon is inserted into the blocked artery and inflated. A slotted metal tube called a stent is then placed inside the artery in the area of the narrowing to hold it open. The stent remains inside the artery permanently.

Cerebral Angiography is a minimally invasive diagnostic test to detect abnormalities in the blood vessels of the head and neck. In this procedure, the Neurointerventional Surgeon inserts a tube called a catheter into an artery in your leg and uses X-ray guidance to advance the catheter up through the abdomen, chest, and into the neck to the artery to be examined. Once there, contrast material (dye) is injected through the catheter and several sets of X-rays taken. The catheter is then removed. The technique is performed under local anesthesia and minimal sedation (as it is not painful) and takes less than an hour. It can detect or confirm conditions such as aneurysm, AVM, AVF, carotid artery disease or other abnormalities within the blood vessels of the brain.

Spinal Angiography is a minimally invasive diagnostic test to detect or confirm abnormalities in the blood vessels in your spine. In this procedure, the Neurointerventional Surgeon inserts a catheter into an artery in your leg and uses X-ray guidance to find the area to be examined. Once there, contrast material (dye) is injected through the catheter and several sets of X-rays taken. The catheter is then removed.

The procedure takes between one and three hours and is usually performed under general anesthesia to ensure you remain perfectly motionless for best results. It is used to diagnose conditions such as AVMs, AVFs of the spinal cord. If a problem is found, the physician may also perform an Endovascular Embolization to treat it.  

Tumors of the head and neck often develop a significant blood supply, raising the risk of excessive bleeding during surgical removal. Neurointerventional Surgeons use Endovascular Embolization to cut off the blood supply to these tumors, enabling a quicker, simpler surgery with far less blood loss.

The minimally invasive embolization procedure is performed several days prior to surgery. First, the Neurointerventional Surgeon performs a Diagnostic Angiogram to identify the source of the tumor’s blood supply. Then, a soft, flexible catheter is fed via a sheath inserted inside an artery of the groin to the tumor site and a various substances, such as small particles or glue, are injected to block the blood flow.

Officially known as the Intracarotid Sodium Amobarbital Procedure (ISAP), this test often goes by the nickname Wada, after the physician who first performed it, Dr. Juan Wada. It is done before certain types of brain surgery to determine which side of the brain controls language function and which side has better memory function. Results help the neurosurgeon facilitate operative planning and improve the surgical result.

The Neurointerventional Surgeon injects a short-acting anesthetic into your right or left carotid artery, putting one side of your brain to sleep for a few minutes. When EEG (brain wave) recordings confirm that your brain is asleep, a neurological exam is performed by your Neurologist, who is also present. Different objects and pictures are shown. When the anesthetic wears off, you will be asked what you saw. The same procedure is repeated on the other side.

An ischemic stroke occurs when a blood vessel feeding the brain suddenly becomes clogged, cutting off vital blood flow and oxygen supply to that area of the brain. Neurointerventional Surgeons are able to quickly enter the artery of the groin and drive a long tube called a catheter to the area of blockage. Once there, the Neurointerventional Surgeon is then able to open up the blockage by using a vacuum device to aspirate the blood clot (Penumbra System) or using a self-expanding stent-retriever (Solitaire or Trevo). Whatever method is used, the goal is the reestablishment of blood flow past the area of blockage, thereby limiting damage to the brain and allowing for better recovery.

Stroke is a medical emergency! Treatment is most effective when given within the first few hours, so it’s important to recognize the symptoms and act quickly. If you suspect a stroke, call 911 immediately. EMS can begin vital treatment in the ambulance.

Stroke symptoms include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Endovascular Embolization is a minimally invasive treatment to block uncontrolled bleeding of the head or neck due to trauma, tumors or even severe nosebleeds. In this technique, the Neurointerventional surgeon inserts a catheter into an artery in the groin and guides it to the blood vessels involved. Contrast dye is injected through the catheter and X-rays taken to identify the problem. The physician then injects small particles or glue which acts to seal the vessel and stop the bleeding.

The procedure is performed under local or general anesthesia and takes approximately one hour, depending on the complexity of the problem.

Vertebral compression fractures (VCF) are breaks in the bones (vertebrae) that form the spinal column. The most common cause is osteoporosis, but tumors, trauma and other medical conditions can also cause VCFs.

• Kyphoplasty is a minimally invasive procedure to treat these fractures. In this technique, the physician inserts a hollow needle into the affected vertebra and uses an inflatable balloon-like device to create a cavity. Cement is then injected into the cavity. It stabilizes the broken vertebra to relieve pain.
• Vertebroplasty is similar to kyphoplasty, but instead of creating a cavity, the physician injects the cement directly into the bone via the hollow needle.

Kyphoplasty and Vertebroplasty are performed under sedation and usually take less than 1 hour. You and your Neurointerventional Surgeon will determine the treatment that is best for you.