May 29, 2024

Interventional Neurology: A Comprehensive Exploration of Cutting-Edge Neurological Interventions

Interventional Neurology

Neurointervention is a subspecialty of neurology that uses minimally invasive image-guided techniques to diagnose and treat neurological disorders. These techniques are used as alternatives or complements to traditional open surgery. Through small punctures in the skin, interventional neurologists are able to access areas of the brain, spine and surrounding blood vessels to perform various procedures. Some of the most common applications of Interventional Neurology include treating brain aneurysms, brain arteriovenous malformations (AVMs), and stroke.

Treating Cerebral Aneurysms

A cerebral aneurysm is a weak or thin spot on a brain artery that balloons out and fills with blood. When the aneurysm ruptures, it causes a subarachnoid hemorrhage which can lead to brain damage or death. Interventional neurology specialists are able to access the aneurysm using a small catheter that is guided through the arteries all the way to the brain. Once in position, various minimally invasive techniques can be used to treat the aneurysm without traditional open surgery. Some common endovascular treatments for aneurysms include coiling, in which tiny coils are deposited into the aneurysm to promote clotting, and stent-assisted coiling to widen the neck of the aneurysm for better coil placement. These treatments aim to exclude the aneurysm from the circulation over time to prevent rerupture.

Treating Brain AVMs

An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins in the brain that bypasses the normal circulation. This predisposes to hemorrhagic stroke if the AVM ruptures. Interventional procedures aim to occlude or block the AVM from the normal blood flow using embolization techniques. Similar to aneurysm coiling, interventional neurology specialists will navigate a catheter to the location of the AVM and deploy detachable coils or liquid embolic agents to pack the abnormal vessel connections. Multiple such “glueing” sessions are sometimes needed to completely obliterate the AVM. This minimizes the risk of future hemorrhage and reduces the need for major open surgery.

Acute Stroke Intervention

When an acute ischemic stroke is caused by blockage of a major brain artery, rapid recanalization of that occluded vessel can help minimize brain injury from the stroke. Interventional neurology specialists play a key role in appropriately selecting stroke patients who may benefit from a minimally invasive thrombectomy procedure to physically remove or dissolve the clot. Using a catheter with a stent retriever or thrombus aspiration device, the clot can often be removed from the blocked vessel within hours of symptom onset. Several landmark clinical trials have proven the efficacy of endovascular thrombectomy in improving outcomes for large vessel occlusion strokes. This has rapidly increased the utilization of acute neurointerventional stroke procedures in comprehensive stroke centers.

Pain Management with Neurolytics

Chronic neuropathic pain conditions like trigeminal neuralgia, postherpetic neuralgia and facet joint pain often do not adequately respond to medications. Image-guided injections of neurolytic agents such as alcohol or phenol aim to temporarily or even permanently denervate the targeted nerves causing the pain signals. Using fluoroscopy or CT guidance, interventional neurology specialists can precisely place the tip of the needle in the area of the target nerve and inject small volumes of the neurolytic substance. This results in localized nerve destruction to provide weeks to months of pain relief, thus minimizing the need for opiate medications or even open neurosurgical rhizotomies in some cases.

Conclusion

In summary, Interventional Neurology has expanded the treatment armamentarium for many complex neurological disorders. With improvements in microcatheters, imaging guidance, and new devices, interventional procedures continue to provide less invasive options that reduce risks compared to traditional open surgery. Wider availability of acute stroke interventions especially has transformed the management of ischemic strokes. As the field progresses, more conditions such as spinal diseases, epilepsy and neurodegenerative disorders may also benefit from innovative interventional techniques. This underscores the increasing role of interventional neurologists as part of comprehensive stroke centers and neurointerventional programs.

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