Endovascular neurosurgery, also known as interventional neuroradiology (INR) and endovascular surgical neuroradiology (ESNR) is brain surgery performed from inside blood vessels. Doctors thread catheters through blood vessels, pass tiny instruments through the catheters and use those instruments to conduct the procedures.
Most endovascular procedures require only a small incision in the skin over the femoral artery in the leg to access a major blood vessel and insert the catheters. This makes endovascular neurosurgery a form of minimally invasive surgery—typically less painful and allowing for shorter recovery time than traditional surgery.
Since the surgical site inside the body is not visible to the naked eye during endovascular neurosurgery, doctors use radiology to conduct the procedure. Specific techniques of radiology include fluoroscopy, digital subtraction angiography and computerized soft-tissue imaging scans like CT, MRI, ultrasound and others.
Endovascular neurosurgery can be used in a variety of conditions.
Endovascular techniques may be used in emergency procedures to treat stroke caused by a blood clot. Endovascular techniques may deliver the clot-busting medication tPA directly to the clot. Or an endovascular device called a stent-retriever may prop open the blocked blood vessel and retrieve the clot. Suction catheters may be delivered to the clot in the brain artery to remove it and restore blood flow to the brain.
Atherosclerosis can be treated with endovascular techniques called angioplasty and stenting. In angioplasty, a balloon-like tool inflates inside an artery, opening it up. Then a mesh tube called a stent props the artery open.
An endovascular technique called embolization can help treat aneurysms, blood vessel malformations like AVM and DAVM, and tumors. In this technique, the lesion is filled with a glue-like substance, tiny metal coils or another material. This treatment causes the blood inside the lesion to clot. Embolization may be used alone as a treatment, or as part of preparation for open surgery.
Sclerotherapy is an endovascular technique in which a solution of salt or alcohol is injected into a venous or lymphatic malformation, shutting down the malformed veins or lymph system.
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. The field is developing rapidly as new technology becomes available, and its terminology seems to be developing just as quickly.
Time and again, studies demonstrate that experienced surgeons and interventional radiologists at neuroscience centers of excellence achieve the best possible patient outcomes.
Our team has been performing endovascular procedures longer than any other team in the tri-state area. Our endovascular team consists of expert endovascular neurosurgeons and interventional neuroradiologists. They use the latest technology and the most up-to-date research. Many of the new devices and techniques in the field are developed and tested at Columbia University Medical Center/NewYork-Presbyterian Hospital by our neuroendovascular team.
Dr. Sean Lavine, Dr. Grace Mandigo and Dr. Philip Meyers are our specialists in endovascular neurosurgery. Any of them can offer you a second opinion.
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