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.
When is Endovascular Neurosurgery performed?
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 prop 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 the 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.