Neurointerventional surgery: Minimally invasive, but highly impactful

Neurointerventional surgery is a surgical specialty combining various aspects of neurosurgery, neurology and neuroradiology. Surgeons in this highly specialized field perform minimally invasive but highly impactful procedures paired with sophisticated medical imaging to treat and diagnose disorders of the brain, neck and spine. 

How is neurointerventional surgery performed?

Neurointerventional surgery is performed by a specially trained and certified neurointerventional surgeon. Most procedures use a catheter, which is a tiny, hollow, flexible tube that is inserted in an artery or vein through a tiny incision. Procedures are typically performed through the femoral artery in the leg and occasionally through the radial artery in the wrist.

How catheters and imaging guide the procedure

With the help of real-time medical imaging from an advanced system capturing high-resolution 2D and 3D images of brain and spinal cord blood vessels, the catheter is guided by the surgeon through the vascular system to the area where diagnosis or treatment is needed.

Once the desired area is reached, the neurointerventional surgeon can inject contrast dye to get the highest resolution images possible of the arteries or veins and pass small instruments through the catheter to perform procedures.

Because neurointerventional surgery is minimally invasive with only tiny incisions paired with local anesthesia, recovery time is shorter and the chance of complications is smaller.

How does neurointerventional surgery help?

Neurointerventional surgery is used to treat disorders of the veins and arteries in the brain, neck or spine. It’s also useful to diagnose and treat injuries and trauma to the head and neck.

It can be used to embolize, or purposefully block the flow of blood through specific vessels, to treat multiple types of vascular defects, such as:

• Cerebral aneurysm
• Arteriovenous malformation
• Dural arteriovenous or carotid cavernous fistula (abnormal connections between arteries and veins)
• Middle meningeal artery
• Epistaxis (nosebleeds)
• Tumors of the head or neck

Neurointerventional surgery can also be used to treat strokes or to place stents, for example:

• Thrombectomy for acute ischemic stroke
• Dural venous sinus thrombosis treatment
• Carotid artery stenting
• Intracranial angioplasty/stenting
• Venous sinus stenting for idiopathic intracranial hypertension (intense pressure in the skull)/pulsatile tinnitus (ringing in the ears)

Diagnostic uses of neurointerventional surgery

Sometimes, neurointerventional surgery is key to diagnosing issues in the brain or spine using diagnostic angiography, an X-ray procedure using contrast dye and a catheter to better view the blood vessels in high resolution detail. It can also be used for diagnostic testing, such as balloon test occlusion, inferior petrosal sinus sampling and Wada testing.

It can also be used on pediatric patients to treat disorders such as vein of Galen malformations, dural sinus malformations, arteriovenous malformations, pial arteriovenous fistulas, retinoblastoma or vascular malformations of the head and neck.

The future of neurointerventional surgery

The field of Neurointerventional surgery is growing quickly due to rapid advances in technology. Prior to the widespread use of specialized neurointerventional procedures, invasive, open brain surgery was the only approach to treat brain conditions. 

Catheter-based, minimally invasive approaches are progressively becoming the gold standard for treatment of neurovascular disease of the brain and spine.