Interventional neurology is a medical specialty that focuses on minimally invasive treatment options for various neurological disorders and conditions. By using imaging guidance such as X-ray fluoroscopy, computed tomography (CT) scans or magnetic resonance imaging (MRI), interventional neurologists are able to access the brain and spinal cord through small punctures in the skin. This allows them to deliver treatments directly to the site of involvement without requiring more invasive surgery. Some of the main procedures performed include stroke treatments, vascular malformation repairs and treatments for pain, among others.
Endovascular Treatment for Acute Ischemic Stroke
One of the most impactful advances has been the development of endovascular therapies for acute ischemic stroke. Ischemic strokes are caused by a blockage obstructing blood flow to the brain, often from a blood clot. Traditionally, the only FDA-approved treatment was a “clot busting” medication called tPA given within 4.5 hours of stroke onset. However, only a small percentage of people receive this medication due to the narrow treatment window. Interventional treatments allow doctors to access the blocked vessel via the groin and physically remove or dissolve the clot. Several randomized controlled trials in recent years have demonstrated significantly improved outcomes with endovascular therapies compared to standard medical management alone. As a result, endovascular procedures are now the standard of care for appropriate stroke patients presenting within 6-24 hours of symptom onset in comprehensive stroke centers.
Endovascular Options for Brain Aneurysms and AVMs
Another focus of interventional neurology is the treatment of brain vascular malformations like aneurysms and arteriovenous malformations (AVMs). Brain aneurysms are balloon-like bulges in the wall of an artery within the brain that can rupture and leak blood, causing a potentially life-threatening hemorrhagic stroke. Previously, many aneurysms required open neurosurgery for repair. Now, interventional neurologists can delicately navigate microcatheters and wires into the cerebral vasculature to deliver coils, stents or liquid embolic agents to occlude the aneurysm from within—avoiding the invasiveness of surgery. Similarly, AVMs which are tangled abnormal connections between arteries and veins, predisposing to hemorrhage, can now be embolized using particles delivered through microcatheters rather than open resection when the AVM involves an unfavorable location.
Peripheral Nerve and Facet Joint Procedures for Pain Management
Another large arm of interventional neurology focuses on image-guided treatments for various types of chronic pain. Conditions like failed back surgery syndrome, complex regional pain syndrome and peripheral neuropathies can greatly impact quality of life. When pain cannot be managed with medications, interventional techniques offer minimally invasive options. Radiofrequency ablation procedures use heat generated from an electrode tip to disrupt the transmission of pain signals along peripheral nerves or from joints like facet joints in the spine. Neurolytic blocks deliver medication such as alcohol or phenol to locally “deaden” overactive nerves. Pumps implanted to continuously deliver medication directly to targeted nerve structures have also shown success in some refractory pain states. While not curative, these interventions aim to provide months to years of relief from debilitating pain and improve function.
Emerging Technology in Interventional Neuroradiology
The field of interventional neurology continues to advance rapidly with evolving technologies. Wider bore microcatheters now enable retrieval of larger clots from large vessel occlusions compared to older models. New mechanical thrombectomy devices like stentrievers physically capture and extract clots more effectively than prior technologies like the Merci retriever. Flow diversion stents that work like “bricks and mortar” have emerged as an alternative option for some complex aneurysms previously considered high-risk for coiling or surgical clipping.
Developments in neuroimaging also fuel new applications. High resolution 3D rotational angiography provides incredibly detailed live images of the intracranial vessels to help navigate increasingly smaller catheters and guide deployment of new devices. Fusion imaging combining pre-procedure MRI/CT with real-time fluoroscopy enhances visualization of underlying vessel and soft tissue anatomy. Advances like functional neurostimulation mapping may expand the boundaries of what conditions are amenable to minimally invasive approaches rather than open surgery alone. Biodegradable implants, drug-eluting bioabsorbable material applications and novel embolic agents also show promise on the horizon.
Conclusion
In conclusion, interventional neurology has revolutionized treatment options for many neurological disorders. By delivering targeted, image-guided therapies directly to the site of pathology, patients are spared the risks and recovery time of major open surgery. Constant innovation also means more complex, previously inoperable conditions may now benefit from minimally invasive solutions. As new technologies continue emerging, interventional approaches will likely play an even greater role—not only impacting outcomes, but improving quality of life for those affected by neurological disease.
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