Advanced Minimally Invasive Treatment for Brain, Spine & Vascular Disorders
Neurointervention is a specialised field of modern medicine that uses minimally invasive, image-guided techniques to diagnose and treat diseases involving the blood vessels of the brain and spinal cord.
Most procedures are performed through a small puncture, usually in the wrist or groin, without the need for open brain surgery. Advanced catheter-based techniques can be used to remove blood clots, treat brain aneurysms, block abnormal blood vessels, open narrowed arteries and manage selected vascular and tumour-related conditions.
At SRI Brain Centre, neurointerventional treatment is offered as part of a comprehensive approach combining conventional neurosurgery and advanced endovascular treatment.
A stroke occurs when the blood supply to a part of the brain is interrupted or when a blood vessel in the brain ruptures. Ischemic stroke, caused by blockage of a blood vessel, is the most common type.
Some patients with a major blood-vessel blockage may benefit from mechanical thrombectomy, an advanced endovascular procedure in which a catheter is used to remove the clot and restore blood flow to the brain.
Symptoms of stroke
Remember BE-FAST:
* B – Balance: Sudden loss of balance or coordination
* E – Eyes: Sudden difficulty seeing
* F – Face: Facial weakness or drooping
* A – Arm: Sudden weakness or numbness
* S – Speech: Difficulty speaking or understanding speech
* T – Time: Seek emergency medical attention immediately
Other symptoms may include sudden severe headache, dizziness, confusion or difficulty walking.
Neurointerventional treatment
Depending on the type and timing of stroke, treatment may include:
* Mechanical thrombectomy
* Intra-arterial treatment in selected situations
* Angioplasty or stenting for selected arterial blockages
* Treatment of underlying vascular abnormalities
Stroke is a medical emergency. Every minute matters.
A brain aneurysm is an abnormal bulging or ballooning of a blood vessel in the brain. Some aneurysms remain asymptomatic and are discovered incidentally, while others may rupture and cause subarachnoid haemorrhage, a potentially life-threatening form of stroke.
Symptoms of a ruptured aneurysm
A ruptured aneurysm can cause:
* Sudden, extremely severe headache
* Vomiting
* Neck stiffness
* Loss of consciousness
* Seizures
* Neurological weakness
A sudden severe headache that reaches maximum intensity within seconds should be treated as an emergency.
Endovascular treatment
Many aneurysms can be treated from inside the blood vessel without open surgery.
Treatment options may include:
* Coil embolization
* Balloon-assisted coiling
* Stent-assisted coiling
* Flow-diverter treatment
* Other specialised endovascular techniques
The most appropriate treatment depends on the aneurysm’s size, location, shape, relationship with surrounding vessels and the patient’s overall condition.
A brain AVM is an abnormal connection between arteries and veins in which blood flows directly from arteries into veins without passing through the normal capillary network.
AVMs can sometimes cause:
* Brain haemorrhage
* Seizures
* Headache
* Weakness or other neurological symptoms
Some AVMs are discovered incidentally.
Diagnosis
Detailed vascular imaging is important for treatment planning. Digital subtraction angiography (DSA) is often considered an important investigation for understanding the feeding arteries, nidus and draining veins of an AVM.
Endovascular embolization
During embolization, a microcatheter is navigated into selected feeding vessels and a specialised embolic material is delivered to reduce or block abnormal blood flow.
Embolization may be used:
* As definitive treatment in selected AVMs
* Before surgery
* As part of a combined treatment strategy with surgery or radiosurgery
Treatment must be individualised because AVMs vary considerably in their anatomy and risk.
A dural arteriovenous fistula (dAVF) is an abnormal connection between arteries supplying the dura and veins or venous sinuses.
The symptoms and risks depend largely on the location and venous drainage pattern of the fistula.
Patients may experience:
* Pulsatile tinnitus
* Headache
* Eye symptoms
* Neurological symptoms
* Seizures
* Intracranial haemorrhage in high-risk lesions
Treatment
Endovascular embolization is an important treatment for many dAVFs.
A catheter is guided to the abnormal vascular connection and an embolic agent is used to close the fistula and eliminate abnormal venous drainage.
In selected patients, complete obliteration of the fistula can provide definitive treatment.
The carotid and vertebral arteries supply blood to the brain. Narrowing or blockage of these arteries can reduce blood flow or cause blood clots to travel to the brain, resulting in a TIA or stroke.
Causes
Common causes include:
* Atherosclerosis
* Arterial dissection
* Other vascular disorders
Treatment
Treatment depends on the severity of narrowing, symptoms, anatomy and overall stroke risk.
Management may include:
* Medical treatment
* Carotid endarterectomy in appropriate patients
* Carotid artery stenting
* Vertebral artery intervention in selected cases
Endovascular treatment involves navigating a catheter through the arterial system and placing a stent across the narrowed segment when appropriate.
Intracranial arterial stenosis refers to significant narrowing of an artery within the brain.
It is an important cause of ischemic stroke, particularly in populations with a high burden of intracranial atherosclerotic disease.
Symptoms
Patients may experience:
* Transient ischemic attacks
* Recurrent strokes
* Weakness or numbness
* Speech difficulty
* Visual symptoms
Treatment
Medical management is the foundation of treatment for most patients and may include antiplatelet therapy, cholesterol management, blood-pressure control and management of other vascular risk factors.
In carefully selected patients with severe symptomatic stenosis and recurrent ischemic events despite optimal medical therapy, endovascular treatment such as angioplasty or intracranial stenting may be considered.
Patient selection and treatment at an experienced centre are essential because intracranial interventions have specific risks.
Some brain and skull-base tumors have a rich blood supply. Meningiomas, for example, can sometimes receive substantial blood flow from branches of the external carotid artery or other vascular territories.
Role of neurointervention
In selected hypervascular tumors, preoperative embolization may be considered.
The goal is to reduce the tumor’s blood supply before surgery, which may potentially help with:
* Reducing intraoperative blood loss
* Improving surgical visualisation
* Facilitating tumour removal in selected cases
Tumor embolization
Angiography is first performed to identify the arteries supplying the tumor and to assess potentially dangerous connections to normal brain or cranial nerves.
A microcatheter can then be selectively positioned in appropriate feeding vessels and an embolic material delivered.
Tumor embolization requires detailed knowledge of neurovascular anatomy and must be performed only when the potential benefits outweigh the risks.
The veins and venous sinuses of the brain drain blood from the brain back toward the heart. Disorders affecting these vessels can sometimes produce significant neurological symptoms.
Cerebral Venous Sinus Thrombosis
A clot within the cerebral venous sinuses can cause:
* Headache
* Seizures
* Visual disturbances
* Neurological deficits
* Intracranial hypertension
Most patients are initially treated with anticoagulation. In selected severe cases, endovascular treatment may be considered.
Venous Sinus Stenosis
Narrowing of the cerebral venous sinuses can be associated with idiopathic intracranial hypertension (IIH) in selected patients.
Patients may experience:
* Persistent headaches
* Pulsatile tinnitus
* Transient visual obscurations
* Papilledema
* Progressive visual impairment
In appropriately selected patients, venous sinus stenting may be considered after detailed evaluation.
Vascular malformations can occur in the spinal cord and its surrounding structures.
Examples include:
* Spinal arteriovenous malformation
* Spinal dural arteriovenous fistula
* Spinal arteriovenous fistula
These conditions can cause progressive neurological problems, including:
* Weakness
* Numbness
* Difficulty walking
* Bladder or bowel dysfunction
* Spinal cord haemorrhage
Spinal angiography
Detailed spinal angiography is often required to identify the arteries supplying the lesion and understand its relationship with critical spinal cord vessels.
Endovascular treatment
In appropriately selected cases, embolization can be used to close the abnormal vascular connection and prevent further damage.
Because spinal vascular anatomy is complex, careful angiographic evaluation is essential.
A chronic subdural hematoma occurs when blood accumulates between the brain and its outer covering, usually developing over days to weeks.
It is particularly common in older adults and may cause:
* Headache
* Memory or behavioural changes
* Weakness
* Difficulty walking
* Drowsiness
* Confusion
Surgery, particularly burr-hole drainage, remains an important treatment for symptomatic patients.
Middle Meningeal Artery Embolization
Middle meningeal artery embolization (MMAE) is an increasingly used minimally invasive treatment for selected patients with chronic subdural hematoma.
A catheter is introduced into the arterial system and navigated to the middle meningeal artery. An embolic material is then used to reduce blood flow to the vascular membranes associated with the hematoma.
MMA embolization may be considered in selected situations, including some patients with recurrent chronic subdural hematoma or patients at high risk of recurrence.
The decision between surgery, embolization or combined treatment depends on the individual patient’s clinical and radiological findings.
Neurointerventional procedures require specialised knowledge of the delicate blood vessels of the brain and spinal cord.
A dual-trained neurosurgeon and neurointerventionist can evaluate patients from both surgical and endovascular perspectives and determine whether the most appropriate approach is:
At SRI Brain Centre, treatment decisions are based on the patient’s symptoms, imaging, vascular anatomy, overall health and the risks and benefits of available treatment options.
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