July 23, 2024

Interventional Neurology: Nurturing Neurological Well-Being through Innovation

Interventional Neurology

Interventional neurology is a rapidly advancing medical specialty that uses minimally invasive techniques to diagnose and treat various neurovascular diseases of the brain and spine. Trained in both neurology and neuroradiology, interventional neurologists are able to accomplish procedures through small catheters and wires inserted through the skin rather than traditional open surgery. Some of the common procedures performed include:

Diagnosing Strokes

When a patient comes to the emergency room experiencing stroke symptoms such as sudden weakness, numbness or trouble speaking, it is critical to quickly determine what type of stroke it is in order to guide treatment. Traditional magnetic resonance imaging (MRI) or computed tomography (CT) scans can often identify ischemic strokes caused by a blood clot but have difficulty determining hemorrhagic strokes caused by a ruptured blood vessel. Interventional neurologists are able to thread a catheter through the femoral or radial artery all the way to the brain where small particles can be injected to clearly visualize arterial anatomy and detect any bleeding sites not seen on initial scans. This angiogram procedure takes only 30-60 minutes and provides vital information for determining the best course of treatment.

Treating Strokes

For ischemic strokes caused by a large vessel occlusion, interventional treatments have been shown to significantly improve patient outcomes compared to medical management alone. Using real-time x-ray imaging, interventional neurologists can safely navigate catheters and microcatheters through the arterial system directly to the site of the clot. A variety of restoration devices such as stent retrievers are then deployed to remove the clot and restore blood flow to the deprived brain region. For the highest risk anterior circulation large vessel occlusions, recent studies have demonstrated complete reperfusion can be achieved in over 70% of patients, with nearly half regaining independence after three months compared to just one-third with standard care.

Managing Brain Aneurysms

An aneurysm is a weak, bulging spot on a blood vessel in the brain that fills with blood. Untreated aneurysms carry a significant risk of rupture which can cause a devastating hemorrhagic stroke. Through a small punction site in the groin, an interventional neurologist is able to thread a catheter beyond the aneurysm and deploy innovative coils, stents or liquid embolic agents to seal off the aneurysm from the circulation. Coil embolization has largely replaced open craniotomy and clipping as the primary treatment for unruptured aneurysms, carrying far less risk and faster recovery time. For ruptured aneurysms, interventional techniques allow treatment at earlier stages to improve outcomes.

Treating Spinal and Cerebral Angiomas

Vascular malformations such as spinal or cerebral cavernous angiomas are abnormalities of blood vessels that carry an elevated risk of potentially dangerous bleeding within the brain or spinal cord. Rather than relying on open microsurgical resection which risks damaging critical neural tissues, interventional techniques can often safely and effectively treat these conditions through minimally invasive embolization via catheter. Under roadmap guidance, the precise location of malformations can be identified and slowly packed with particles over multiple sessions to safely obliterate the abnormal vasculature and relieve future risk of hemorrhage without open surgery.

Avoiding the Need for Shunts

Conditions causing abnormal accumulation of fluid on the brain such as hydrocephalus can require surgical diversion of excess fluid through an external shunt system, which carries lifelong risks of infection and malfunction. Interventional treatments deploy new technologies like catheters with one-way valves to directly restore flow within the brain’s natural fluid circulation pathways in select cases, avoiding the need for an external shunt entirely. Additional approaches use small amounts of acrylic glue or bumetanide to seal off sites of fluid overproduction rather than relying on a shunt’s diversion alone, offering non-surgical alternatives.

Advancing Tumor Treatments

Precise delivery of embolic materials, glues or radioactive therapies directly into brain tumors allows interventionalists to build upon advances in neuro-oncology. Techniques are being developed to seal arteriovenous malformations feeding high-grade gliomas to restrict blood supply and sensitise them to chemotherapy. Trial studies are exploring convection-enhanced delivery methods threading catheters through small burr holes to locally infuse drug therapies or even oncolytic viruses directly within tumor boundaries. Whenever possible, these targeted interventional approaches aim to supplement or possibly replace the need for open surgery, whole brain radiation or less selective systemic drug treatments.

Growing Role of Interventional Neurology

As new technologies and restoration devices continue to be developed, the field of interventional neurology is set to play an integral role in improving care and outcomes for numerous challenging neurologic diseases. Beyond the current areas of stroke, aneurysm and AVM intervention, capabilities are rapidly expanding into flow alterations, tumor therapies, spinal interventions, extracranial reconstruction and more. Combined with core training in neurology, interventionalists are uniquely positioned at the intersection of both medical and surgical specialties – able to diagnose, monitor and treat neurological conditions through minimally invasive, targeted approaches whenever possible. With further research and innovations, interventional techniques hold great promise for advancing treatments across the full breadth of neuroscience.

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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it