Interventional neurology is a specialized medical discipline focused on conditions affecting the brain, spinal cord, and surrounding blood vessels. This field offers advanced approaches to diagnose and treat complex neurological disorders.
Understanding Interventional Neurology
Interventional neurology is a distinct subspecialty within neurology that uses minimally invasive, image-guided techniques to diagnose and treat diseases of the brain, spinal cord, head, and neck vasculature. This field operates at the intersection of neurology, neurosurgery, and radiology, drawing upon expertise from each discipline. Its unique focus involves reaching affected areas through blood vessels, rather than traditional open surgery.
The approach centers on endovascular procedures, which means working from inside the blood vessels. These procedures are performed with the aid of advanced imaging technologies, such as fluoroscopy and angiography, providing real-time visualization for precise navigation. This allows for targeted interventions with smaller incisions, which can lead to reduced recovery times compared to more invasive methods.
Conditions Treated
Interventional neurologists address a variety of neurological conditions. One is acute ischemic stroke, which occurs when a blood clot blocks blood flow to a part of the brain. This blockage can cause brain cells to die due to lack of oxygen and nutrients. Prompt treatment is important to restore blood flow and reduce potential damage.
Cerebral aneurysms are another condition treated in this field. An intracranial or cerebral aneurysm is a weakened, bulging area in the wall of a blood vessel in the brain. While many do not cause symptoms until they become large or rupture, a ruptured aneurysm can lead to severe bleeding around the brain, known as a subarachnoid hemorrhage.
Arteriovenous malformations (AVMs) are abnormal tangles of blood vessels that directly connect arteries and veins, bypassing the normal capillary system. These malformations can occur in the brain or spinal cord and carry a risk of bleeding. Carotid artery stenosis involves the narrowing of the carotid arteries, which are major blood vessels in the neck supplying blood to the brain. This narrowing is typically caused by plaque buildup, a condition called atherosclerosis, and can restrict blood flow, increasing the risk of stroke.
Minimally Invasive Procedures
Interventional neurology utilizes minimally invasive, catheter-based procedures. One prominent procedure is mechanical thrombectomy, used for acute ischemic stroke caused by large vessel occlusion. A thin tube, or catheter, is inserted, usually through an artery in the groin, and guided to the blocked blood vessel in the brain. Specialized devices are then used to physically remove the blood clot, restoring blood flow.
For cerebral aneurysms, endovascular coiling is a common treatment. In this procedure, soft platinum coils are delivered through a catheter into the aneurysm. These coils fill the aneurysm, promoting blood clotting within it and effectively sealing it off from normal blood flow, which reduces the risk of rupture.
Carotid artery stenting is a procedure performed to treat carotid artery stenosis. A catheter is inserted and guided to the narrowed carotid artery. A small metal mesh tube, called a stent, is then deployed to prop the artery open, improving blood flow to the brain and reducing stroke risk.
The Interventional Neurologist
Becoming an interventional neurologist requires extensive and specialized medical training. This path begins with completing a general neurology residency. Following residency, neurologists typically pursue further fellowship training in vascular neurology or neurocritical care. These foundational fellowships provide a deep understanding of brain and spinal cord diseases, especially those related to blood vessels and critical care management.
After these initial fellowships, aspiring interventional neurologists then complete a dedicated neurointerventional training program, which typically lasts one to two years. This advanced fellowship focuses on mastering the image-guided, catheter-based techniques used in diagnostic and therapeutic procedures. Interventional neurologists evaluate patients in both emergency and non-emergency situations, carefully weighing the benefits and risks of interventions. They often work as part of a multidisciplinary team, collaborating with emergency physicians, neurosurgeons, and neuroradiologists to provide comprehensive care.