The team of vascular neurosurgical specialists at Norton Neuroscience Institute focuses on the treatment of blood vessels in the brain. These specialists are experienced in treating all disorders of the cerebrovascular system, such as stroke, aneurysm and other conditions. Some of the latest, most advanced treatments used by our team include complex aneurysm coiling through microsurgery, arteriovenous malformation (AVM) resection, carotid endarterectomy, embolization and frameless noninvasive stereotactic radiosurgery.
One of the latest approaches in the treatment of aneurysms, AVMs and other conditions that cause stroke or neurological damage is endovascular neurosurgery. This breakthrough technique allows our neurosurgical specialists access to diseased areas in the brain via catheters inserted through blood vessels. This minimally invasive technique is used to treat neurological conditions without craniotomy, or open surgery, which can mean less risk of complications and a shorter recovery.
Conditions we treat:
- Cerebral ischemia
- Cranial arteriovenous malformation
- Spinal arteriovenous malformation
- Venous malformation
When treating cerebrovascular and other conditions, our goal is to provide the best, most effective treatments possible using the most current minimally invasive endovascular technology.
Our endovascular neurosurgeons insert a tiny, thin, flexible tube (catheter) into the patient’s leg artery and thread it through the blood vessels. The surgeon uses X-rays and other imaging techniques to guide the catheter to the area of the body that needs treatment. This innovative technique allows the surgeon to provide treatment for neurological conditions with only a tiny incision, which can mean less risk of complications and a shorter recovery.
This is one technique used to treat brain aneurysm — an abnormal bulging in an artery in the brain that develops in a weak area of the blood vessel wall. An aneurysm can leak blood into other brain tissue, causing damage to brain cells; or it can rupture, which may cause a stroke or even death.
Until recently, most brain aneurysms were treated by clipping off the bulging area during an open procedure (a large incision into the skull). Now, the most common and highly successful aneurysm treatment is an endovascular treatment known as coiling. A catheter is inserted into the patient’s leg, then into the head to the aneurysm. Thin platinum coils are threaded into the aneurysm, filling it to block blood flow and keep it from rupturing. Patients receive this treatment — also known as embolization — under light sedation or general anesthesia. More than 125,000 patients around the world have been treated with a coiling procedure.
Though technology and minimally invasive surgical techniques are continually improving, some cerebrovascular conditions still require a traditional, open surgery. Your neurosurgeon can advise you on the most appropriate treatment for your condition.
Endovascular Neurosurgery: Current and Emerging Technologies
Endovascular neurosurgery is an emerging field that allows the surgeon to treat many neurological conditions with minimally invasive techniques, when traditionally these conditions required complex open surgeries. These conditions include cerebrovascular diseases, such as stroke, aneurysms, tumors and arteriovenous malformations (AVMs). Sometimes a case that is deemed untreatable using conventional surgery may be treatable using endovascular techniques. Rather than accessing the brain from the outside using a knife and drill, endovascular techniques allow these diseases to be treated from the inside through blood vessels that naturally lead to the brain from the femoral artery in the leg. In most cases, this type of treatment does not carry the same risk and extended recovery when compared to a craniotomy, or open brain surgery.
With an estimated one in every 50 people in the U.S. living with a brain aneurysm, viable endovascular procedures to repair or remove aneurysms are imperative. The neurosurgeon inserts a tiny catheter through the patient’s groin and maneuvers it to the aneurysm. The aneurysm is then packed with platinum coils or bypassed by a stent, called a Pipeline, essentially creating a new vessel and shutting off the blood supply to the aneurysm. “The Pipeline is a microcatheter-delivered stent that is able to divert blood away from an aneurysm,” said Shervin R. Dashti, M.D., Ph.D. “It’s a quantum leap in aneurysm treatment. The aneurysm gets no blood and essentially closes off.”
Pipeline and coiling are minimally invasive and often safer than traditional surgery. Plus they result in shorter hospital stays and recovery time, as well as fewer complications. Endovascular techniques also are helpful in embolizing vascular tumors in the brain, where operating can pose serious challenges to control blood loss. These techniques can block vessels that supply blood to a tumor while the surgeon works to remove the tumor.
The endovascular neurosurgeons at Norton Neuroscience Institute also are providing more comprehensive care for stroke patients. Interventional procedures to treat ischemic stroke are now available in our community. “To treat ischemic stroke, we have to dissolve or remove the clot that is preventing blood from reaching an area of the brain,” said Tom L. Yao, M.D. “We can use small catheters to infuse thrombolytics directly into the clot to dissolve it or use new devices, such as the Solitaire Revascularization Device, to remove clots and restore blood flow.”
The Solitaire device is the latest breakthrough in clot removal. This stentlike device widens the interior walls of the artery to re-establish blood flow in the brain. The clot then seeps into the mesh of the stent and, after several minutes, the device and clot are removed. “Traditionally many procedures to treat these conditions were done with craniotomy or large open surgery,” Dr. Yao said. “Now they are minimally invasive, and many patients go home the next day.”
Drs. Dashti and Yao are experienced in the latest techniques in endovascular therapy, making some of these emerging technologies available for the first time to patients in Greater Louisville. In addition to performing these techniques, Drs. Dashti and Yao have completed extensive training in and performed traditional open neurosurgeries. It is important to keep in mind that in some cases traditional surgery is indicated over endovascular techniques.
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