Interventional Neurology
Interventional Neurology is a non-surgical neurology subspecialty in which diseases of the brain and spinal cord vessels are treated from within the blood vessels using angiography-guided imaging techniques.
Interventional Neurology is a non-surgical subspecialty of neurology that utilizes imaging guidance and angiographic techniques to treat diseases of the brain and spinal cord vasculature via an endovascular approach.
In this field, access to the cerebral vessels is gained via the femoral or radial artery. Conditions such as stroke, cerebrovascular occlusions, aneurysms, and arteriovenous malformations (AVMs) can be treated without the need for open surgery.
Scope of Practice in Interventional Neurology
Interventional neurology enables the management of many serious diseases affecting the brain and spinal cord vasculature using advanced endovascular treatment techniques, often eliminating the need for surgery. The following outlines common therapeutic applications in this field:
Acute Stroke Therapy
In stroke patients presenting within the therapeutic window, mechanical thrombectomy or pharmacologic thrombolysis can be performed to remove the occluding clot and restore cerebral blood flow. This can significantly reduce the extent of permanent disability caused by the stroke.
Carotid and Cerebral Artery Stenosis
Occlusions in the cervical and cerebral arteries can be treated with balloon angioplasty and stenting. Procedures on neck vessels are often performed with the patient awake, while intracranial vascular interventions are typically conducted under general anesthesia.
Cerebral Aneurysms
Aneurysms that develop in the cerebral vessels often present with intracranial hemorrhage. If left untreated, they can lead to death or permanent neurological deficit. Endovascular treatment modalities include coil embolization, stent-assisted coiling, or balloon-assisted techniques. In select cases, standalone stent placement may be sufficient. Rarely, the parent artery harboring the aneurysm may be occluded.
Arteriovenous Malformations (AVMs) and Fistulae
Congenital or acquired vascular malformations and fistulae in the brain, spine, and head-neck region can be partially or completely occluded by the intra-arterial delivery of embolic agents. While these procedures can be curative in some patients, in other cases they are used as a preparatory step prior to surgery or radiotherapy.
Preoperative Embolization of Hypervascular Tumors
Preoperative embolization of tumors such as nasopharyngeal angiofibromas, meningiomas, and hemangiomas, using specialized embolic agents to occlude their feeding vessels, minimizes potential intraoperative blood loss. In some cases, this method can also serve as a primary treatment modality.
Vascular Occlusion and Test Procedures
The scope of interventional neurology also includes temporary balloon test occlusions of vessels like the carotid artery prior to surgery, as well as permanent vascular occlusion procedures when indicated.