Lesions Previously Thought Inoperable Now Treated With Neuroendovascular Surgery

Neuroendovascular surgery is an emerging specialty combining the skills of neurosurgery and interventional neuroradiology. These minimally invasive techniques have proven effective in the diagnosis and treatment of strokes, brain aneurysms, tumors, arterial venous malformations (AVMs), intracranial atherosclerosis, blocked carotid, vertebral and subclavian arteries, from inside the blood vessel. Patients benefit because neuroendovascular surgery results shorter hospital stays, fewer possible complications, less pain, and a quicker recovery period. Some patients even return to work the day after surgery, as opposed to weeks or even months with traditional surgery.

Typically, neuroendovascular procedures begin with angiography of the brain, face or spine. This is to confirm the diagnosis and generate a “road map” of the vessels associated with the area of abnormality. Neuroendovascular surgery requires only a small nick in the leg to gain access to a blood vessel, usually an artery. From this point of entry, the lesion is reached by navigating a catheter through blood vessels using X-ray guidance. With these minimally invasive procedures, potentially life-threatening conditions can now be treated without opening the skull, neck or back.

The methods used to treat these pathologies continue to evolve, and the technological advances are making it safer and easier for the patient. As a group, Carolina Neurosurgery & Spine Associates is committed to the comprehensive care of all vascular pathology related to the brain and spinal cord - from aneurysms, AVMs, and atherosclerosis as well as acute stroke treatment.


Conditions Successfully Treated With Neuroendovascular Surgery
Following are a few examples of how neuroendovascular surgery is now making treatment possible for a variety of life-threatening conditions.

Aneurysms
Many aneurysms can be difficult to treat using traditional neurosurgical techniques because of their location in the brain, or due to patients’ other medical problems. These same aneurysms can now be treated by utilizing neuroendovascular techniques, with many patients able to leave the hospital the next day and return to work immediately.

Stroke
There are over 700,000 ischemic strokes per year in the United States alone, making it the third leading cause of death and the most common cause of disability. Using interventional techniques, the treatment window for acute ischemic infarct can be significantly longer than the three hour window now available with intravenous medications.

In terms of stroke prevention, angioplasty with stenting is an excellent alternative for high risk patients with atherosclerosis of the extracranial carotid arteries. This method is rapidly becoming the treatment of choice for diseases involving the subclavian or extracranial vertebral arteries.

Intracranial Atherosclerosis
Intracranial atherosclerosis has recently been recognized as having a tremendously high risk of ischemic stroke. Long term anticoagulation with warfarin has been the mainstay of treatment. However, stroke rates with maximal medical therapy range from as low as 10 % per year, to as high as 30 % per month. This makes intracranial stenosis about four to five times more dangerous than an unruptured aneurysm or AVM. Because of recent advances in stent design, angioplasty and stenting can now be used to treat clinically significant disease of the intracranial vessels.

Arterial Venous Malformations
An arterial venous malformation (AVM) is a tangle of blood vessels in the brain that can cause intracranial bleeding. Utilizing neuroendovascular techniques, a catheter can be used to block the blood vessels of the AVM with liquid adhesive or small particles, thus reducing or eliminating the AVM’s blood supply. Such reductions make surgical removal of the AVM quicker and safer.

Tumors
Tumors of the head and neck, as well as some brain tumors, can also be treated to either make surgery safer or as a primary treatment along with radiation therapy. For example, many tumors have significant blood supply that can lead to uncontrolled bleeding during conventional open surgery. By using neuroendovascular surgery to block the blood vessels that supply the tumor prior to surgery, tumor removal becomes quicker, easier, and safer. This type of treatment may also reduce the need for a patient to receive blood transfusions during and after surgery.

For more information, or to refer a patient, click here or call Carolina Neurosurgery & Spine Associates at 800-344-6716 (Charlotte area) or 336-272-4578 (Greensboro area).
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