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What is an interventional neuroradiology doctor?

Interventional neuroradiologists, otherwise known as neurointerventional radiologists, neurointerventionalists, or endovascular neurosurgeons, are doctors who perform procedures upon the brain or spine without making large incisions. Instead the minimally invasive procedures are performed through the blood vessels, or through small needles. The use of “neuro” in “Neurointerventional” means we particularly focus on treatments for disease or disorders of the nervous system located within the head, neck and spine systems of the body. They use advanced imaging equipment to guide their procedures.

Are interventional neuroradiologists surgeons?

Interventional neuroradiology procedures are extremely complex procedures requiring a high degree of manual dexterity and anatomical knowledge and many years of training. Another name for the specialty is endovascular neurosurgery. A distinction is often made from the more traditional open microvascular neurosurgery which involves making incisions in the skull to perform procedures under a microscope.

Many practitioners come from a background in radiology, which might seem odd at first. However, the specialty evolved from first performing diagnostic procedures, called angiograms, by injecting substances into the bloodstream to visualise diseases. After many advances in techniques and technology practitioners were able to actually treat diseases using tiny instruments directly inside the blood vessels themselves. As well as radiology, practitioners may also have backgrounds in neurosurgery, and neurology.

Are these techniques safe or are they considered experimental?

Whilst the specialty is relatively new, interventional neuroradiology employs techniques that have been proven, through rigorous clinical trials, to be safe and effective. Many vascular diseases of the brain and spine, previously treated through open surgery, can now be treated with reduced complication rates associated with the interventional neuroradiology. As an added benefit there is usually reduced pain and shorter recovery time. Neurointerventionalists work closely with other specialists including neurosurgeons to ensure that the correct treatment is chosen. Many of our patients are referred to us by our surgical colleagues who also recognize the benefits of minimally invasive treatments.

What are the most common types of diseases that you treat?

There are many conditions treated by interventional neuroradiologists.

Brain aneurysms are bulges on the wall of an artery. We treat them before they burst to prevent a stroke. In the emergency setting we also treat aneurysms that have already burst to stop further bleeding. Approximately 3% of the population have brain aneurysms, however not all of these are dangerous and need treating.

We treat stroke patients by removing the clot which is blocking the artery in the brain. If this is done quickly enough (normally just a few hours after the stroke onset) then the prognosis is much better. Stroke is one of the leading causes of death in the United Kingdom.

We treat stenosis (narrowing) in the blood vessels of the neck or brain using stents or balloons in order to increase the blood flow and prevent stroke.

We treat a disease called arteriovenous fistula, which is an abnormal connection between arteries and veins within the brain or spine. This causes abnormally high pressure in the veins and can lead to symptoms such as tinnitus, vision or hearing loss, or stroke. A related condition, known as arteriovenous malformation, can also often be treated using interventional techniques.

We often treat patients with tumours of the brain, face, or neck who are going to have a surgical resection. We can often shrink the tumour down by blocking the blood flow (embolisation) using tiny particles.

A common procedure that we perform is called a cerebral angiogram. “Cerebral” meaning brain, “angio-” meaning blood vessel, and “-gram” indicating that an X-ray is being performed. This is a diagnostic, minimally invasive procedure to diagnose diseases of the blood vessels of the brain.

How do interventional neuroradiologists perform their procedures?

This is achieved via inserting a tiny tube called a catheter into an artery or vein. The usual entrance site is the groin or the wrist, as these are easily accessible and safe places. We then advance the tube into the blood vessel involved in the disease process. We can place tiny devices, such as coils or stents, or retrieve blood clots, through these tubes. As the tubes inside the body we use advanced imaging equipment, such as X-rays, CT, or MRI to guide them.