Treatments

Interventional Neuroradiology

Posted on by Prof. Dr. Özgür KILIÇKESMEZ

Interventional neuroradiology is a branch of medicine that relies on advanced technology. It plays a critical role in diagnosing and treating vascular diseases in vital areas such as the brain, head and neck region, spine, and spinal cord. This specialty uses endovascular (non‑surgical) techniques to intervene in diseases and guide treatment processes. Therefore, it has a central role in managing life‑threatening conditions such as stroke and aneurysm. Interventional neuroradiology aims to provide maximum benefit with minimally invasive methods in patient care.

How Does Interventional Neuroradiology Work in Treating Brain Aneurysms?

Interventional neuroradiology uses various innovative methods to treat brain aneurysms. Advances in this field offer safer and more effective treatment options for patients. The devices and techniques used during the procedure play a critical role in aneurysm treatment:

  • Flow Diversion: In this method, a stent‑like device is placed in the main artery. The device diverts blood flow away from the aneurysm, promoting clot formation and leading to gradual aneurysm occlusion.
  • Saccular Flow Disruption: The WEB (Woven EndoBridge) device, designed for wide‑necked bifurcation aneurysms, disrupts flow within the aneurysm sac to treat it.
  • Stent‑Assisted Coiling: This technique involves placing a stent across the aneurysm neck. The stent secures coils inside the aneurysm sac and prevents them from herniating into the parent artery.

What Role Does Interventional Neuroradiology Play in Stroke Management?

Interventional neuroradiology has a central role in stroke treatment. This subspecialty incorporates high‑tech diagnostic and therapeutic methods, especially for acute ischemic stroke. These rapid and effective interventions increase the chances of functional recovery and reduce mortality.

Diagnostic Tools:

  • Advanced CT and MRI determine stroke type and the extent of brain injury.
  • Diffusion‑weighted imaging quickly detects ischemic changes.

Treatment Methods:

  • Endovascular thrombectomy removes large‑vessel occlusions.
  • Intra‑arterial thrombolysis accelerates clot dissolution.

How Does Interventional Neuroradiology Help in Treating Arteriovenous Malformations (AVMs)?

Interventional neuroradiology plays a critical role in managing AVMs. Endovascular embolization provides targeted treatment of abnormal vessels. In this procedure, the arteries feeding the AVM are accessed minimally invasively to reduce blood flow and minimize hemorrhage risk. The embolic agents used include:

  • Onyx (liquid embolic “glue”)
  • Coils

These agents are delivered via catheter to occlude feeding vessels, starving the AVM. Superselective neuroangiography and high‑field MRI improve procedural success. Embolization results in AVM size reduction and effective management before and after surgery or radiosurgery. As technology advances, embolization efficacy and safety continue to improve, enhancing outcomes and lowering morbidity and mortality.

What Is the Importance of Interventional Neuroradiology in Spinal Vascular Disorders?

Interventional neuroradiology is critical in managing spinal vascular disorders. This specialty addresses complex conditions like spinal vascular malformations. High‑resolution imaging techniques that detail spinal vascular anatomy enhance success. Advanced catheter technologies adapt to complex anatomies, increasing procedural safety and effectiveness.

  • Diagnosis and Classification: Conditions such as AVMs and dural arteriovenous fistulas are accurately classified for appropriate management strategies.
  • Treatment of Spinal Vascular Malformations: Endovascular methods offer effective alternatives to traditional surgery.
  • Minimally Invasive Approach: Treatments that minimize physical trauma accelerate recovery and reduce risk.
  • Technological Advances: Improved imaging and catheter designs enable more precise interventions.
  • Innovative Therapies: Emerging technologies are transforming spinal vascular disorder management and expanding treatment options.

How Is Interventional Neuroradiology Used in Carotid Artery Disease Treatment?

Interventional neuroradiology plays an important role in treating carotid artery disease. Two main endovascular treatments are used: carotid artery stenting (CAS) and carotid endarterectomy (CEA).

Carotid Artery Stenting (CAS):

  • Recommended for high‑surgical‑risk patients.
  • Preferred for anatomies unsuitable for surgery.
  • Modern devices enhance safety and success.

Carotid Endarterectomy (CEA):

  • Offers lower perioperative stroke risk.
  • Long‑term studies show effective stroke reduction.
  • Ideal for patients with suitable anatomy and low surgical risk.

Hybrid techniques like transcarotid artery revascularization may further reduce stroke risk.

What Advances Exist in Interventional Neuroradiology for Brain Tumor Treatment?

Interventional neuroradiology has made significant advances in brain tumor treatment, improving both efficacy and precision:

  • Targeted Alpha Therapy: Delivers alpha‑emitting radiation directly to cancer cells, sparing surrounding tissue and offering hope for aggressive tumors like glioblastoma.
  • Intra‑arterial Chemotherapy: Delivers chemotherapeutic agents directly to the tumor’s arterial supply, maximizing local effect and minimizing systemic side effects.
  • Minimally Invasive Techniques: Catheter‑based interventions allow treatment of hard‑to‑reach tumor areas, speeding recovery and improving post‑treatment quality of life.

Advanced imaging and AI integration—such as MRI perfusion and AI‑driven planning—enhance diagnostic accuracy and treatment planning, ushering in a new era of neuro‑oncologic care.

How Does Interventional Neuroradiology Help Manage Chronic Subdural Hematomas?

Interventional neuroradiology offers significant benefits in managing chronic subdural hematomas through middle meningeal artery embolization. This minimally invasive approach effectively reduces hematoma recurrence and size. It is an alternative for high‑risk surgical patients or those with recurrent hematomas:

  • Reduces hematoma recurrence rate.
  • Low complication profile.
  • Success assessed by CT imaging.

Embolization leads to hematoma reduction and midline shift improvement, making it ideal for elderly or medically complex patients.

What Applications Does Interventional Neuroradiology Have in Head and Neck Vascular Lesions?

Interventional neuroradiology offers multiple treatments for head and neck vascular lesions. These minimally invasive interventions serve as alternatives to high‑risk surgery:

Embolization of Vascular Tumors:

  • Used for juvenile nasopharyngeal angiofibroma and paraganglioma.
  • Reduces tumor blood flow to facilitate surgery.

Treatment of AVMs and Fistulas:

  • Aims to occlude abnormal vascular connections.

Aneurysm and Pseudoaneurysm Management:

  • Stabilizes vessel walls to reduce rupture risk.

Percutaneous Sclerotherapy:

  • Injects sclerosants for venous and lymphatic malformations.

Radiofrequency Ablation and Cryoablation:

  • Thermally ablates tumors.

Trauma Management:

  • Embolization treats vascular injuries.

Epistaxis Treatment:

  • Embolizes bleeding nasal vessels for severe nosebleeds.

How Does Interventional Neuroradiology Contribute to Intracranial Atherosclerosis Treatment?

Interventional neuroradiology is vital for managing intracranial atherosclerosis using advanced endovascular techniques. Intracranial angioplasty and stenting are used to treat narrowed arteries:

  • Angioplasty dilates narrowed vessels.
  • Self‑expanding stents maintain vessel patency.

These methods help prevent ischemic strokes and improve quality of life. Innovations like drug‑coated balloons aim to enhance outcomes. However, risks remain, and comparative studies (e.g., SAMMPRIS) guide patient selection and technique refinement.

What Role Does Interventional Neuroradiology Play in Pediatric Neurological Conditions?

Interventional neuroradiology plays an important role in treating pediatric cerebrovascular and spinal conditions. Minimally invasive methods and advanced imaging allow effective management of childhood vascular malformations and tumors:

Vascular Malformations:

  • Arteriovenous malformations
  • Vein of Galen malformations
  • Dural sinus malformations

Stroke and Aneurysms:

  • Pediatric ischemic strokes
  • Childhood aneurysms

Tumor Management:

  • Paraganglioma
  • Meningioma

These interventions reduce symptoms and prevent progression, offering significant benefits for pediatric patients.

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