Neurointerventions
Neurointerventions/ endovascular neurosurgery
Neurointervention is a word used to describe the minimal invasive endovascular treatment approach to conditions that occur within the vessels of the brain or within the spinal cavity. The diseasees and conditions that are treated by Neurointerventions are- brain aneurysm ( ballooning inside the brain vessel), brain arteriovenous vascular malformations, Dural AV fistulas, carotid stenosis and acute brain stroke ( presenting within the window period of 6-8 hours). Because neurointerventional treatments are considered less invasive than more traditional modes of open surgery yet yield optimal treatment outcomes, they are often attractive options to patients. Also few patients with multiple comorbidities like uncontrolled diabetes, hypertension, cardiac disease i.e. patients who are not fit for open surgery, old age are a good candidate for this minimal invasive approach of neurointervention. Moreover hospital stay of the patient with the neurointervention method is much less as compare to open brain surgery.
Brain aneurysm
A life threatening condition that usually present with intracranial bleeding. 15- 20 % patient could not make it to the hospital once the aneurysm bleeds. Approx. 40-45% patients die/ survive with permanent disabilities if brain aneurysm is not promptly treated. Prompt treatment of aneurysm increase the survival in these patients.
While CT and MRI scans can show many aneurysms, most patients will undergo a cerebral angiogram (DSA) for definitive diagnosis and to determine the best treatment option. An angiogram is an invasive procedure in which a catheter (resembling a flexible tube) is inserted into the groin and guided up through the vessels to the site of the aneurysm. A liquid dye is injected into the vessel so that highly detailed pictures can be taken, revealing the location, size and shape of the aneurysm. This precise information is then used to determine the best treatment option for the patient.
Two modalities to treat the aneurysm are surgical clipping (which is done by a neurosurgeon) after opening the skull bone. Alternative less invasive approach is endovascular coiling (done by neurointervention). Neurointerventionist first inserts a catheter, resembling a long tube, into the groin and then thread it up through the vessels to the problem site inside the brain. Once the catheter is in place, coils are placed inside the aneurysm. These mesh wires prevent blood flow from entering the aneurysm and thereby reduces the pressure that would otherwise cause it to burst.
Acute stroke
Acute stroke occurs when a blood clot blocks an artery that carries blood to the brain. Deprived of oxygen, brain cells die very fast, increasing the risk of permanent brain damage, disability or death. Recognizing symptoms (Sudden numbness or weakness of the face, arms or leg – especially on one side of the body, Sudden confusion or trouble speaking or understanding speech, Sudden trouble seeing in one or both eyes, Sudden trouble walking, dizziness) getting medical attention quickly can save a life and minimize disability.
“Time is brain” The faster treatment can be initiated, the better the chance of a successful outcome. Current FDA-approved therapies include clot-busting medications (t-PA) that can be administered intravenously (through a needle in the arm) within 4.5 hrs of symptom onset, as well as certain devices to be used by a neurointerventionist that can break up or remove the clot (mechanical thrombectomy) when applied within six- eight hours of symptom onset.
Carotid stenosis
Carotid vessel supplies blood to brain. Narrowing of this vessel by cholesterol/ fatty deposit can cause major stroke. Two procedures that can open up the narrowed vessel are – carotid endarterectomy ( open surgery in neck to remove the fat) and carotid stenting ( interventional procedure to open the artery). The procedure of Carotid angioplasty and stenting is done by a small puncture in groin there by navigate in neck artery. It opens the narrowed blood vessel so that blood supply to brain improves and can prevent future strokes. In contrast to open surgery (carotid endarterectomy) carotid angioplasty is less invasive procedure to be done under local anaesthesia with much less hospital stay. Patients with multiple risk factors for open surgery are a good candidate for carotid angioplasty.
