Neurointerventional surgery encompasses the practice of fluoroscopically-guided endovascular procedures for pathologies involving the craniocervical and spinal regions, minimally-invasive spinal procedures, and other percutaneous interventions of the head and neck.
Endovascular procedures are catheter-based. Vascular access can be arterial or venous, and is classically achieved from the femoral region. Innovations in both devices and techniques have also increased the use of the radial artery as access site. Diagnostic angiography as well as pharmacological or device-based therapeutics may be performed using a combination of catheters and guidewires of various sizes. Digitally-subtracted angiography (DSA) is the gold standard for imaging vascular diseases of the craniocervical and spinal regions. These translate into many pathologies treatable by neurointerventional surgery. They include ischemic stroke, intra- and extracranial atherosclerotic disease, cerebral and cervical aneurysms and pseudoaneurysms, cranial and spinal arteriovenous malformations and fistulae, venous stenosis, and idiopathic intracranial hypertension, to name a few.
Percutaneous spinal procedures primarily target diseases that have resulted in anatomical misalignment or compression of the spinal canal. These procedures can normalize vertebral height, relieve nerve root compression, re-establish spinal alignment, and most importantly, provide minimally-invasive solutions to spinal or radicular pain. Under fluoroscopic guidance, rarer diseases such as lymphovascular malformations can also be treated with percutaneous sclerotherapy.
As a rapidly growing field, Neurointerventional surgery also continues to expand its therapeutic offering as more and more diseases, both pediatric and adult, become treatable via its minimally-invasive approach. It is a young subspecialty at the confluence of Neuroradiology, Neurosurgery, and Neurology. As such, it is also known by several other names: Interventional Neuroradiology, Endovascular Neurosurgery, Interventional Neurology, and Endovascular Surgical Neuroradiology. Neurointerventional surgery is a unique subspecialty in the practice of Medicine where each of three parent specialties collaborates and contributes to its constant innovations.