Endovascular neurosurgery is a discipline that combines  neurosurgery with a field called “interventional neuroradiology.” Instead of open operations, this  minimally invasive technique uses x-ray imaging, catheters, and various embolic (clotting) agents to treat diseases of the blood vessels of the brain and spine.  The “surgery” is performed in a fluoroscopy suite rather than an operating room, and the procedure is done  within the blood vessels by using catheters to fill blood vessel abnormalities with obstructing particles, polymers or stents (see "An Aneurysm Treatment Primer" below to understand the illustrations).

Historically, the techniques of interventional neuroradiology were used along with open neurosurgery. Currently, many of these techniques can be the only treatment necessary for various diseases. An example of this is the treatment of complex cerebral aneurysms when the risk of open operations  exceed the risk of endovascular surgery. Some aneurysms, due to the size or location within the brain are very difficult to treat successfully and safely with traditional neurosurgical techniques.  Over the last decade, the effectiveness and safety of endovascular neurosurgery has improved and catheter  techniques have become the treatment of choice for certain aneurysms. This can be the case with cerebral aneurysms near the brainstem, such as basilar artery aneurysms.  

Endovascular surgery of cerebral aneurysms is performed by placing a flexible catheter within the femoral artery (the artery  supplying the leg) and advancing the catheter into the arteries which feed the aneurysm within the head.  Detachable coils and stents can be injected to block the flow of blood into the aneurysm and cause the aneurysm to become clotted. A team of experienced neurosurgeons and interventional radiologists can best determine treatment for these challenging problems.

Endovascular techniques can treat a variety of intracranial disorders:

• Aneurysms

• Arteriovenous malformations

• Carotid cavernous sinus fistulae

• Dural avm's

• Vascular tumors

• Vasospastic arteries

• Arterial stenosis

• Cerebral revascularization after clotting

Case Study:
An aneurysm of the basilar artery, situated at the base of the brain and technically difficult to operate was successfully treated by endovascular coils.

A cerebral aneurysm is a saccular bulging of the wall of an artery. The cause is a structural weakness in the wall of the artery. For hydrodynamic reasons, these bulges appear at places where arteries divide into smaller branches. These aneurysms slowly enlarge with time and may rupture, causing bleeding within the brain. Many individuals do not survive spontaneous hemorrhage for aneurysms.