Endovascular Neurosurgery

Endovascular neurosurgery AKA neuroendovascular surgery, endovascular and surgical neuroradiology (ESNR), interventional neuroradiology (INR) or interventional neurology (IN), combines catheter based techniques and imaging for the diagnosis and treatment of specific cerebral and spine conditions. Training is certified by the Committee on Advanced Subspecialty Training (CAST).y

Also known as interventional neuroradiology (INR) and endovascular surgical neuroradiology (ESNR) is brain surgery performed with endovascular technique.

Remarkable developments in the field of endovascular neurosurgery have been witnessed in the last decade. The success of endovascular therapy for ischemic stroke treatment is now irrefutable, making it an accepted standard of care. Endovascular treatment of cerebral aneurysms is no longer limited to primary coiling but now includes options such as stent or balloon assistance and flow diversion and applications utilizing neck reconstruction, intrasaccular, and bifurcation-specific devices. Balloons, liquid embolic agents, and flow-directed catheters have revolutionized the treatment of arteriovenous malformations and fistulae. The ongoing development of endovascular tools has led to novel and expanding approaches (for example, transvenous embolization of arteriovenous malformation and transradial access). With improved technology, transposterior communicating artery access and other endovascular strategies are being applied successfully across the anterior and posterior circulations and to lesions once deemed only surgically approachable. Yet, we would be remiss to attribute the successes of endovascular strategies only to the development of their tools. Improvements in both noninvasive and angiographic imaging (such as three-dimensional road map guidance) have provided a greater understanding of pathologic entities and allowed the pursuit of endovascular cures 1).

Doctors who perform endovascular surgery must have an excellent command of two different specialties: neurosurgery and radiology. Depending on their backgrounds, doctors who perform endovascular neurosurgery are called either endovascular neurosurgeons, interventional neuroradiologists or interventional neurologists. Endovascular neurosurgeons trained originally as neurosurgeons and then received specialized training in radiology. Interventional neuroradiologists trained originally as radiologists and then received specialized training in neurosurgery. Interventional neurologists trained originally in neurology followed by training in endovascular neurosurgery.

In fact, endovascular neurosurgery itself goes by an array of names: neuroendovascular surgery, neurointerventional surgery, interventional neuroradiology and endovascular surgical neuroradiology, for example.

see Endovascular Neurosurgery History.

● uncorrected (life-threatening) bleeding disorders

● relative contraindications:

○ poor renal function (due to iodine dye load): hemodialysis can be arranged in emergent situations; alternatively, patient may be hydrated and monitored for return to baseline creatinine

○ connective tissue disorder that predisposes to vessel dissection

○ severe allergy to iodine contrast: requires prior administration of “dye allergy prep”

○ major atheroma of aortic arch or plaque/atherosclerosis of great vessels (innominate, subclavian, common carotid artery) due to high risk for thromboembolic complications

○ for spinal angiography: thoracic aortic aneurysm (relative)

Levy EI, Munich SA, Rosenwasser RH, Kan P, Thompson BG. Introduction: Endovascular Neurosurgery. Neurosurg Focus. 2019 Jan 1;46(Suppl_1):V1. doi: 10.3171/2019.1.FocusVid.Intro. PubMed PMID: 30611172.
  • endovascular_neurosurgery.txt
  • Last modified: 2021/05/06 09:01
  • by administrador