Endovascular Neurosurgery

What is endovascular neurosurgery?

It is a type of brain surgery done from inside the blood vessels. Catheters are navigated through the blood vessels and micro instruments are passed through them to do the procedure. It is done through a small incision in the skin over the groin to access the main blood vessel in the thigh and catheters are navigated into the brain under X-ray control. Since the incision is for needle entry it is called Pinhole surgery.

The procedure is entirely done under X-ray control in a special room called cath lab and utilizing a technique called digital subtraction angiography. Here the skull bones are subtracted and brain vasculature is well seen.

What are the different types of treatment available?

• In emergency to treat a stroke
  • by introducing clot busters to dissolve the clot
  • Removing the clot by suction method
  • By using a metal stent

  All these aim to restore the blood flow.

  By using this technique the treatment of stroke has taken a paradigm shift

• Atherosclerosis by using
  • Angioplasty: inflating a balloon inside the artery
  • Stenting: as a scaffold to prevent further narrowing
• Aneurysm by coil embolization using balloon, stent or flow divertor
• Arterial venous malformation: blocking the nidus with embolic material
• Tumors can be embolized with particulate matter making surgery easier with reduced blood loss
• Other malformations like Dural AV fistulae or Pial AVMs
• Spinal vascular malformation
• Bony tumors of spine

Who does it?

• Neurosurgeon experienced in these procedures
• Neurologist with special interest
• Radiologist with special interest 

What are the advantages?

• no scar
• no post procedure pain
• less hospital stay
• faster recovery and early to get back to work

Authored By Dr. Sai Sudarsan