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Vascular Neurosurgery

Count on Banner Brain & Spine when you or a loved one are in need of neurosurgery treatment. Learn more about vascular neurosurgery. 

What is Vascular Neurosurgery?

Vascular neurosurgery involves treating patients with disorders of the blood vessels in the brain and spine.  This requires highly specialized neurosurgeons who have experience treating these disorders. It often requires a multi-disciplinary approach in developing a treatment plan with the neurosurgeon, interventional radiologist and neuroradiologist. 

What Does Vascular Neurosurgery Treat? 

Aneurysms

A cerebral (brain) aneurysm occurs when there is a weak spot in the blood vessel wall that bulges outward, like a balloon that is filling with water. Aneurysms can range in size from very small to very large and can occur anywhere in the brain. If an aneurysm ruptures (bursts), it can cause bleeding into the brain (hemorrhage), which can be life-threatening.

Arteriovenous malformations (AVMs)

An arteriovenous malformation (AVM) is an abnormal connection between the arteries and veins that bypasses the normal network of capillaries. AVMs can occur anywhere in the body, but they most commonly occur in the brain and spine. They are usually present at birth and are thought to be caused by abnormal blood vessel development during fetal development. AVMs can range in size from very small to very large and they can be composed of a single tangled mass of blood vessels or a network of vessels.

AVMs can cause a variety of symptoms, depending on their location and size. They may cause no symptoms at all, or they may cause bleeding into the brain, seizures or neurological deficits. Treatment options for AVMs may include surgery, radiosurgery, embolization procedures  or observation.

Cavernous malformation

A cavernous malformation, also known as a cavernous angioma or cavernoma, is a collection of abnormal blood vessels in the brain or spinal cord. These blood vessels are dilated, thin walled and prone to bleeding.

Cavernous malformations are typically benign (noncancerous) and do not usually cause symptoms. However, if a cavernous malformation bleeds, it can cause problems such as headache, weakness, numbness or difficulty speaking or moving.

Treatment options for cavernous malformations may include medications to prevent bleeding, surgery to remove the malformation or other treatments. The choice of treatment will depend on the location and size of the malformation and the severity of the symptoms.

Dural arteriovenous fistula

A dural arteriovenous fistula (DAVF) is an abnormal connection between an artery and a vein in the dura mater, the outermost layer of the meninges (the protective covering of the brain and spinal cord). A DAVF can cause problems if it allows too much blood to bypass the capillaries and enter the venous system, leading to an increase in pressure in the veins. This can cause symptoms such as headache, changes in vision and weakness or numbness in the limbs. DAVFs can also increase the risk of bleeding in the brain (intracerebral hemorrhage).

Treatment options for DAVFs may include medications to reduce blood pressure and blood flow through the fistula, surgery to repair or remove the fistula or other treatments. The choice of treatment will depend on the specific characteristics of the fistula and the severity of the symptoms.

Moyamoya disease

Moyamoya is a rare and progressive cerebrovascular disorder characterized by a stenosis (narrowing) or occlusion (blockage) of the internal carotid arteries and the formation of abnormal collateral blood vessels at the base of the brain. These abnormal blood vessels, which resemble a "puff of smoke" in Japanese (hence the name "moyamoya"), are thin and fragile and they are prone to bleeding.

Moyamoya typically affects children and young adults, and it is more common in women and in people of Asian descent. The most common symptoms of moyamoya include stroke, transient ischemic attack (TIA) and brain hemorrhage. The treatment for moyamoya disease usually involves surgery to bypass the blocked or narrowed blood vessels and improve blood flow to the brain. This may involve the placement of a synthetic blood vessel or the use of a blood vessel from another part of the body.

Moyamoya is a serious and potentially life-threatening condition, and it requires prompt diagnosis and treatment to prevent further complications.

Carotid artery disease (CAD)

Carotid artery disease is a condition in which the carotid arteries, which are the major blood vessels in the neck that supply blood to the brain, become narrowed or blocked due to the accumulation of plaque. Plaque is a buildup of cholesterol, fat and other substances in the inner lining of the arteries. Carotid artery disease can increase the risk of stroke and other serious health problems.

Symptoms of carotid artery disease may include stroke-like symptoms such as sudden weakness or numbness on one side of the body, difficulty speaking or understanding speech and changes in vision.

Treatment options for carotid artery disease may include medications to lower cholesterol and blood pressure, lifestyle changes (such as quitting smoking and eating a healthy diet) and surgery to remove plaque or to widen the narrowed arteries.

Carotid body tumor

A carotid body tumor, also known as a chemodectoma or paraganglioma, is a rare, noncancerous (benign) tumor that arises from cells in the carotid body, a small structure located near the carotid artery in the neck. Carotid body tumors are typically slow-growing and do not usually cause symptoms. However, if a carotid body tumor becomes large enough, it can press on nearby structures and cause problems such as difficulty swallowing, hoarseness or difficulty breathing.

Treatment options for carotid body tumors may include surgery to remove the tumor, radiation therapy or other treatments. The choice of treatment will depend on the specific characteristics of the tumor and the location and extent of the growth.

Styloidogenic jugular venous compression syndrome (SJVCS)

Styloidogenic jugular venous compression syndrome (SJVCS) is a rare condition that occurs when the styloid process, a small bone in the neck, compress the internal jugular vein, which is a major vein that carries blood from the head and neck back to the heart. This compression can cause a variety of symptoms, including difficulty swallowing, hoarseness, neck pain and headaches.

SJVCS is usually diagnosed using imaging tests, such as x-rays, CT scans, or MRIs and it is treated with medications or surgery. The goal of treatment is to relieve the compression on the jugular vein and alleviate the symptoms. In some cases, this may involve removing the styloid process or part of it. In other cases, a procedure called jugular vein decompression may be used to create more space for the vein and relieve the compression. SJVCS is a rare condition, and it is not well understood. 

Neurosurgery Treatments of Vascular Disorders:

Depending on the type of vascular disorder, your neurosurgeon will discuss surgical options with you. Surgery may involve a craniotomy or neck surgery, endovascular intervention or radiosurgery. It can also be a combination of different approaches. With advances in technology and microsurgical techniques, minimally invasive craniotomies can also be an option in some cases with significant decrease in hospital stay and faster recovery times.

Types of Vascular Neurosurgery:

Bypass surgery in the brain

Extracranial-intracranial bypass is a surgical procedure that is used to improve blood flow to the brain in people with cerebrovascular disease, which is a condition that occurs when the blood vessels that supply blood to the brain become narrowed or blocked.

During the procedure, a healthy blood vessel is taken from another part of the body (such as the leg or chest) and used to bypass the blocked or narrowed artery, allowing blood to flow more freely to the brain.

Extracranial-intracranial bypass is typically performed by a neurosurgeon, and it is usually done under general anesthesia, meaning the patient is unconscious during the surgery. The procedure involves making an incision in the scalp and carefully separating the skin and underlying tissues to expose the blood vessels. The bypass vessel is then attached to the affected artery and the healthy blood vessel and the incision is closed with sutures.

Extracranial-intracranial bypass is a complex and potentially risky surgical procedure and it carries a risk of complications, such as infection, bleeding and stroke.

Carotid endarterectomy

Carotid endarterectomy is a surgical procedure that is used to remove plaque (a buildup of cholesterol, fat, and other substances) from the inside of the carotid artery, a major blood vessel in the neck that supplies blood to the brain. Plaque buildup in the carotid artery can cause the artery to narrow (stenosis), which can reduce or block the flow of blood to the brain and increase the risk of stroke.

Carotid endarterectomy is typically performed by a neurosurgeon or a vascular surgeon, and it is usually done under general anesthesia, meaning the patient is unconscious during the surgery. The procedure involves making an incision in the neck and carefully removing the plaque from the inside of the artery. The artery is then closed with sutures or staples.

Carotid endarterectomy is a safe and effective procedure for many patients with carotid artery stenosis, and it can significantly reduce the risk of stroke. However, like any surgical procedure, it carries a risk of complications, such as infection, bleeding and damage to the artery or nearby nerves.

Embolization

Embolization is a medical procedure in which a small object, such as a coil or a tiny plastic or metal device, is inserted into a blood vessel to block or reduce the flow of blood to a specific area of the body. It is typically used to treat conditions such as aneurysms, arteriovenous malformations (AVMs) and bleeding in the digestive tract or uterus.

During embolization, the physician inserts a catheter (a thin, flexible tube) into a blood vessel and guides it to the area of the body that is being treated. The embolic material is then released through the catheter, where it blocks or reduces the flow of blood to the targeted area.

Embolization is typically performed using x-ray guidance, and it is usually done in a hospital or outpatient setting. The procedure is usually performed under conscious sedation (a light sleep), and the patient is awake, but relaxed during the procedure.

Embolization is a safe and effective treatment option for many patients, and it is often preferred over traditional surgery because it is less invasive and has a shorter recovery time. However, like any medical procedure, it carries a risk of complications, and the decision to undergo embolization should be made after careful consideration and consultation with a qualified health care provider.

Microsurgical resection of arteriovenous malformation

An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels that can occur anywhere in the body, but it is most commonly found in the brain or spine. An AVM can disrupt the normal flow of blood and cause a variety of symptoms, depending on its size and location.

Microsurgical resection of an AVM is a surgical procedure that is used to remove an AVM. It is typically performed by a neurosurgeon or a vascular surgeon, and it involves making a small incision in the skin and using specialized instruments to remove the AVM. Microsurgical resection is a highly specialized procedure that requires advanced training and expertise, and it is usually only performed by experienced surgeons.

During the procedure, the surgeon uses a microscope or other specialized instruments to visualize the AVM and carefully remove it. The procedure is usually performed using general anesthesia, and the patient is unconscious throughout the surgery.

Microsurgical resection of an AVM is a complex and potentially risky procedure, and it carries a risk of complications, such as bleeding, infection.

What is Endovascular Neurosurgery?

Sometimes the endovascular surgery approach is used to treat vascular disorders, as part of the preoperative work up or as a surgical adjunct. It is often performed by neurosurgeons or interventional neuroradiologists. 

Endovascular neurosurgery is a minimally invasive procedure that involves using a catheter to take special pictures in the interventional radiology suite (cerebral angiogram) to see all the blood vessels and if necessary, place coils, glue or stents as part of the treatment. 

With an expert team that specializes in vascular neurosurgery, you can trust Banner Brain & Spine to provide quick answers and a customized treatment plan. Talk to your doctor about the best endovascular neurosurgery procedure for you your condition.