Interventional Neuroradiology

Overview

An autopsy was the only way to reliably identify many brain illnesses a century ago. Decades of study on disease features and technological developments have transformed neuroscience.

Medical imaging, for example, has enabled physicians and scientists to observe the anatomy of the brain as well as changes in brain activity as they occur. However, some of the most significant advances in imaging technology have happened in the last 20 years, resulting in crisper pictures and more detailed functional information.

Radiology has become a significant element of the diagnostic process within neurology, employing medical imaging technologies such as X-ray, ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT). A radiologist is a physician who, after earning a medical degree, pursues additional study in radiography. A neuroradiologist has further specific training in neuroradiology to focus on interpreting pictures of the central nervous system, which includes the brain, spinal cord, and surrounding tissues.

 

What is Interventional Neuroradiology?

Interventional neuroradiology is a specialist practice of neuroradiologists, neurosurgeons, and neurologists who treat vascular disorders of the central nervous system using an endovascular technique. In both the adult and pediatric populations, these disorders include aneurysms, arteriovenous malformations (AVMs), and stroke.

Since the advent of interventional neuroradiology more than four decades ago, technological advances have resulted in advances in scientific knowledge as well as the development of highly efficient endovascular devices, allowing for a better understanding and identification of the vascular lesions that can be treated. Endovascular devices are injected into peripheral blood arteries through catheters and progressed to the vascular abnormalities in the brain or spine.

Once in place, they can be used to prevent bleeding by blocking anomalies within the vessels or to open up blocked arteries to enhance blood flow. Therapeutic devices widely utilized by interventional neuroradiologists include coils, liquid embolic materials, stents, and clot retrieval devices.

Interventional neuroradiology is also engaged in the treatment of traumatic head and neck lesions, pre-operative devascularization of tumors and other vascular masses, and percutaneous spinal operations such as vertebral compression fracture augmentation.

For stroke victims, the time to therapy is critical. Within 30 minutes of arrival, we may transport stroke patients from the emergency room to the operation room and remove clots from blood vessels in the brain.

Interventional Neuroradiology is a radiology specialist that focuses on the diagnosis and treatment of vascular disorders of the brain, head and neck, and spine. Endovascular treatment of these disorders, which uses the body's natural conduits (arteries and veins) to reach the site of disease, can frequently avoid open surgery and allow for a quicker return to normal life.

 

What Does Neuroradiology Look At?

A sub-specialty of radiology, neuroradiology has been around since the 1920s. It can be used to help diagnose and treat brain, spine, head, and neck conditions.

At hospital Diagnostics, the experienced team includes highly qualified technologists and support staff, and specialized neuroradiologists who interpret the images. This helps ensure patients receive a thorough diagnosis, allowing them to save time and focus on treatment options.

 

What Types of Imaging Does Neuroradiologist Interpret?

A neuroradiologist may analyze any sort of medical imaging that creates pictures of the central nervous system and its surrounding components. Depending on your symptoms and medical history, your health care practitioner may request one or more of the following:

CT: CT scans use X-rays and computer technology to produce detailed pictures that aid in the diagnosis of a variety of neurological diseases, including acute stroke, intracranial hemorrhage, aneurysms and other vascular abnormalities, brain tumors, and bone abnormalities of the head and spine. CT is also useful for head and neck imaging, such as assessing the paranasal sinuses and temporal bones, as well as staging or diagnosing head and neck tumors.

MRI: MRI tests combine radio waves and a strong magnetic field to provide extremely clear pictures of the body while avoiding the use of ionizing radiation. Many neurological diseases affecting the brain, such as multiple sclerosis, infections, brain tumors, vascular abnormalities including acute stroke and intracranial hemorrhage, and examining the orbits and pituitary gland, are best diagnosed and monitored with MRI. It is also useful in detecting spinal cord abnormalities such as demyelination, tumors, disc herniations, and degenerative alterations. Some neuroradiologists are also trained to perform spine intervention procedures that treat neck and back pain.

 

Why Should I Choose to Have a Neuroradiologist Conduct My Imaging Procedures?

Only adequately qualified physicians with access to cutting-edge equipment should perform and evaluate radiological procedures. Neuroradiologists get four to six years of specialized post-medical school training in radiation safety to enable the best performance of radiological operations and medical picture interpretation. Other medical disciplines require significantly less imaging instruction, with requirements ranging from a few days to a maximum of ten months.

Neuroradiologists are clinicians who specialize in using medical imaging methods to diagnose and treat illness and damage. They have completed at least ten years of study, which includes medical school, license, a four-year residency, and frequently a one- to two-year fellowship of specialized training, and they are at the cutting edge of imaging technology.  At the end of the day, the neuroradiologist is the expert in medical imaging of the head and neck.

 

Who is the Interventional Radiologist?

A medical doctor who has completed an approved residency program is an interventional radiologist. He or she can then sit for the American Board of Radiology's board test. Following that, the interventional radiologist will undergo a fellowship training program. These specialists collaborate closely with other physicians and play a vital role on the treatment team.

 

What are the Advantages of Interventional Radiology Procedures?

While no therapy is without risk, the hazards of interventional radiology treatments are substantially fewer than those of open surgery, and they represent a significant improvement in medicine for patients. Most treatments may be performed as outpatients or with only a brief hospital stay. In most cases, general anesthesia is not necessary. Risk, discomfort, and recovery time are frequently decreased dramatically. Procedures may be less costly than surgery or other options.

 

Is it Safe? ​

Because radiation safety, radiation physics, the biological effects of radiation, and harm avoidance are all included in interventional and diagnostic radiology training programs, the highest standards of patient safety have been incorporated into the creation of these techniques.

 

What Interventional Neuroradiologist Can Treat? 

• Brain and Spinal Vascular Malformations
• Cerebral Aneurysm – Bulging, weakening of an artery supplying blood to the brain
• Extracranial & Intracranial Atherosclerosis – Hardening of arteries that supply blood to the head and neck
• Head and Neck Tumors
• Neck Lesions
• Severe Nosebleeds
• Stroke/Blood Clot in the Brain
• Subarachnoid Hemorrhage (SAH) – Bleeding/bursting of a blood vessel in the brain

 

What Procedures Do Interventional Radiologists Perform?

Interventional radiologists do a variety of procedures, including:

• Angiography. Angiography is a type of X-ray used to check blood vessels. Because blood vessels do not show up well on a standard X-ray, a special dye must be injected into your blood beforehand. This draws attention to your blood vessels, helping your doctor to detect any issues. Angiograms are X-ray pictures produced during angiography. Angiography is a test that is used to determine the health of your blood vessels and how blood flows through them. It can help to diagnose or investigate several problems affecting blood vessels, including:

• atherosclerosis – narrowing of the arteries, which could mean you're at risk of having a stroke or heart attack
• peripheral arterial disease – reduced blood supply to the leg muscles
• a brain aneurysm – a bulge in a blood vessel in your brain
• angina – chest pain caused by reduced blood flow to the heart muscles
• blood clots or a pulmonary embolism – a blockage in the artery supplying your lungs
• a blockage in the blood supply to your kidneys

Angiography may also be used to help plan treatment for some of these conditions.

• Angioplasty. A balloon-tipped catheter is used in angioplasty to unblock a clogged blood artery and enhance blood flow. The catheter is guided over the obstruction by the clinician using medical imaging, generally live x-rays. After spanning the obstruction, the balloon is inflated to free the blocked channel and enhance blood flow. It can be done with or without the use of a metal mesh tube known as a stent. A stent will be left inside the blood artery to assist maintain it open if one is utilized.
• Embolization. Embolization is a minimally invasive procedure that involves the closure of one or more blood arteries or aberrant vascular channels. Catheter embolization is a treatment in which drugs or synthetic materials known as embolic agents are inserted through a catheter into a blood vessel to block blood flow to the region. Catheter embolization can be used to control or prevent abnormal bleeding in practically any region of the body. Catheter embolization is commonly used to treat the following medical conditions:
  • Bleeding caused by a traumatic injury. Controlling bleeding into the abdomen or pelvis as a result of injuries sustained in a car accident is an excellent candidate for this therapy.
  • Bleeding from GI tract lesions such as ulcers or diverticular disease. Embolization is typically used as the first line of therapy for any type of gastrointestinal bleeding.
  • Bleeding caused by vascular abnormalities. In the circulatory system of the lungs, for example, aberrant vascular channels can emerge between arteries and veins. These aberrant connections can be removed through catheter embolization.
  • Bleeding from a tumor. Embolization can help relieve the discomfort caused by tumor hemorrhage.
  • Long menstrual cycles. Long menstrual cycles or excessive menstrual bleeding caused by uterine fibroid tumors. Embolization might be a great alternative to hysterectomy, or the surgical removal of the uterus. Embolization can decrease and manage excessive menstrual flow by blocking the blood supply to fibroids, which have a substantial blood supply. 
  • Catheter embolization is also used to. close off blood vessels supplying a tumor, especially if the tumor is difficult or impossible to remove. Chemotherapy can also be administered by embolization. A tumor may shrink or continue to grow slowly after embolization, making chemotherapy or surgery a more effective treatment choice.
  • Remove an arteriovenous malformation (AVM) or an arteriovenous fistula (AVF) (abnormal connection or connections between arteries and veins). These channels, which may be found everywhere in the body, including the brain and spinal cord, operate as a short circuit, preventing blood from properly circulating and delivering oxygen where it is required. As an alternative to surgery, treat aneurysms (a bulge or sac produced in a weak arterial wall) by either restricting the artery feeding the aneurysm or sealing the aneurysmal sac itself.
  • Decrease the size of congenital venous malformations (a tangle of veins that did not develop into a normal straight vein) in order to decrease pain, swelling and clot formation.
  • Catheter embolization may be used alone or combined with other treatments such as surgery or radiation.

• Gastrostomy tubes (G-Tube). Some children have medical issues that make it difficult for them to get enough nutrients. A gastrostomy tube (also known as a G-tube) is a tube that is put into the stomach and delivers nourishment directly to the stomach. It's one method physicians can ensure that youngsters who have problems eating get enough hydration and calories. During a brief surgery known as a gastrostomy, a surgeon inserts a G-tube. The G-tube can be left in place for as long as the child need it. After healing, children who have had a gastrostomy can return to their typical activities.
• Intravascular ultrasound. Intravascular ultrasonography (IVUS) generates sound waves and pictures of blood vessels using a transducer or probe. When used to assess the coronary arteries, IVUS may reveal the complete artery wall and offer critical information regarding the quantity and kind of plaque deposition, assisting in determining if you are at risk for a heart attack. Ultrasound does not utilize ionizing radiation, has no known side effects, and may offer clear views of soft tissues that x-ray scans cannot.
• Stent placement. The doctor places a tiny mesh coil (stent) inside a blood vessel at the site of a blockage. He or she expands the stent to open up the blockage. 
• Foreign body removal. The doctor puts a catheter into a blood vessel to remove a foreign body in the vessel.
• Needle biopsy. To take a tissue biopsy, the doctor inserts a tiny needle into practically any area of the body, guided by imaging methods. This form of biopsy can provide a diagnosis without requiring surgery. The needle breast biopsy is an example of this method.
• IVC filters. A tiny device called an inferior vena cava (IVC) filter can prevent blood clots from entering the lungs. The inferior vena cava is a big vein in your body's center. The device is implanted during a brief operation. Veins are blood channels that return oxygen-depleted blood and waste materials to the heart. Arteries are blood arteries that transport oxygen-rich blood and nutrients throughout the body. A deep vein thrombosis (DVT) is a blood clot that originates deep within the body in a vein. When blood hardens and gathers together, it forms a clot. This clot usually originates inside one of the deep veins of the thigh or lower leg.
• Injection of clot-dissolving medicines. The doctor injects clot-dissolving medicines such as tissue plasminogen activator. This medicine dissolves blood clots and increases blood flow to your arms, legs, or organs in your body.
• Catheters insertions. The doctor puts a catheter into a large vein to give chemotherapy medicines, nutrition, or hemodialysis. He or she may also put in a catheter before a bone-marrow transplant.
• Cancer treatment. The doctor gives the cancer medicine directly to the tumor site.
• Endovascular coiling. To stop blood flow, a surgeon inserts a very thin metal wire that creates a coil inside a brain aneurysm. A brain aneurysm is a weakened region in the wall of a cerebral artery. This causes abnormal widening or ballooning. Because the artery wall contains a weak point, the aneurysm is vulnerable to rupture if blood flow is not restricted. Aneurysms can be closed by coiling or cutting them.

 

Conclusion

Interventional Neuroradiology is a radiology specialist that focuses on the diagnosis and treatment of vascular disorders of the brain, head and neck, and spine. Endovascular treatment of these disorders, which uses the body's natural conduits (arteries and veins) to reach the site of disease, can frequently avoid open surgery and allow for a quicker return to normal life.

Interventional radiologists perform illness diagnosis and treatment. They treat a wide range of problems in the body by inserting tiny instruments from outside the body, such as catheters or wires. The radiologist is guided by X-rays and imaging modalities such as CT and ultrasound. For several diseases, interventional radiology can be utilized instead of surgery. It can, in certain situations, avoid the requirement for hospitalization.