In healthcare, neuro-interventional neurosurgery or neurointervention is one of the youngest subspecialties of neuroscience. This specialized field utilizes minimally invasive pinhole punctures in the arm/ groin and innovative imaging techniques to diagnose and treat various brain-related issues.

Think of it as a highway to the brain through a pinhole, which helps doctors study neurovascular structures without opening the head.

Neurointervention is a specialty that treats neurovascular diseases caused by either blockage or rupture of arteries or veins of the brain and spinal cord, leading to devastating strokes. Strokes affect 15 million people each year.

Neurointervention treatments like thrombectomy to open a blocked/clogged artery which is a relatively recent advancement. Mechanical thrombectomy, as it is technically called, helps in either totally reversing a paralysis or significantly reducing the disability if offered in time. The role of intervention in brain diseases, like aneurysms or arteriovenous malformations, has already been well-established in the last two decades. This involves repairing the leaking arteries or veins that have caused a brain hemorrhage in advanced Neurovascular cath labs with a puncture and x-ray control in real time using minute devices. Techniques like tumor embolization help prevent bleeding for some very vascular brain tumors and make surgeries safer things better.

What Is Interventional Neurosurgery?

Neuro intervention is a specialized medical field that uses modern imaging tools to fix brain problems without open surgery. Doctors use tiny tubes (catheters, microcatheters) and high-tech X-rays built-in neurovascular cath labs to visualize and diagnose vascular diseases. These catheters are typically 105 cm long; a Neurosurgeon operates from a meter away under real-time visual control in the cath lab. This requires excellent hand-eye coordination. Neuro-endovascular treatment involves using exact, minute devices like coils, catheters, flow diverters, and many specialized embolic materials, among many other things.  

A ruptured brain aneurysm (an abnormal balloon on a brain artery), which is often life-threatening, can be easily embolized (blocked) very precisely and safely. Similarly, a vital artery supplying blood to the brain, if it gets stopped and causes an acute stroke, can be opened up, restoring blood flow and reversing or minimizing brain damage. It’s like using a particular map and tools to fix things inside the brain without opening it up.

Dr. Vikas Gupta says Neurointervention has come up in the last two or three decades. It has revolutionized the treatment and prevention of neurovascular diseases. The furious developments in its application in various dangerous diseases and the simultaneous evolution and development of newer devices by industry have exciting potential as a precise and minimally invasive treatment for various brain conditions. Advanced techniques allow us to address issues effectively, ensuring better outcomes with quicker recoveries. It’s a remarkable avenue, revolutionizing how we care for neurological health.”

How Vital is Neuro Intervention Diagnostic Proficiency?

Without surgery, a digital subtraction angiogram or DSA for the brain, neck, and spinal cord is a diagnostic test of the brain’s arteries and veins. Newer neurovascular cath labs are similar to coronary angiography but involve advanced technical navigation assisted by features like a roadmap and three sixty-degree assessments of a brain blood vessel. DSA is done whenever a disease affecting a brain artery is suspected. It not only helps in diagnosing a blocked or leaking artery but also studies abnormal vessels, any narrowing which may lead to future risk of stroke.

How Does Neuro-intervention Address Abnormalities?

Neurointervention techniques are deployed to treat neurovascular or brain artery or vein problems without extensive open surgeries in a conventional sense. HerHere’sw it works:

• Brain Hemorrhage: Once they spot a problem, like a leaking or bursting aneurysm or arteriovenous malformation, causing a brain hemorrhage, miniature device coils, meshes, flow diverters, or embolic liquid are deployed precisely at the site to repair the leak. The concept treats the hole by packing, disrupting, or remodeling the artery.
• Gentle Fixes: Unlike traditional surgery, which involves significant cuts and a longer recovery, neuro-intervention methods use small openings, leading to faster healing and less discomfort for the patient.
• Protecting the Brain: If a blood vessel narrowing is diagnosed on a DSA, a major disaster in the form of a stroke can be prevented by repairing that diseased artery. This is called angioplasty; carotid angioplasty is one of the most effective therapies for the prevention of stroke.

How Is Stroke Managed?

A stroke, often referred to as a brain attack, is like a sudden traffic jam in the brain’s blood. The brain is a highly fragile, unforgiving organ that cannot tolerate disruption of its blood supply. Brain cells or neurons start dying within a few minutes of such a disruption. Therefore, an acute brain stroke needs urgent treatment to restore blood supply.

• Clearing the Blockage: When a stroke strikes, in addition to sectional imaging like a CT scan and MRI, a DSA is done quickly to detect the site and extent of the blockage. Then, various tiny devices, ranging from aspiration to snares, are employed to capture the blood clot and open the artery.
• Saving Brain Cells: Stroke requires urgent treatment. Hence, stroke centers have predefined stroke protocols to save time. The aim is to restore the blood supply to the brain as soon as possible and protect precious brain cells from harm. It’s like uniting a pipe to let water flow smoothly again. Current recommendations are acute stroke should be treated as soon as possible, and if a patient reaches the hospital in the first 4.5 hours, a clot-bursting drug is given as per protocol. He offered neurointervention techniques to open these arteries if the blocked artery is significant.
• Quick Response, Better Recovery: The earlier a patient reaches a well-equipped stroke-ready center and clears the blockage, the better the chances of a person recovering from a stroke.
• Minimally Invasive: Unlike major surgeries, neuro-intervention methods involve small needle punctures, leading to quicker healing and less patient discomfort.

Role of Neuro-intervention in Brain Tumors

In the realm of brain tumors, neuro-intervention is mainly an adjunctive role  :

•     Reducing the blood supply: Some brain tumors are highly vascular, meaning while subjecting them to surgery, there are chances of very high blood loss. In such tumors as neuro angiofibroma of the nose, carotid body tumors, hemangioblastomas, and various other tumors, it is a joint decision of the surgeon and interventionist to preoperatively embolize (block off the blood supply) of cancer to make the surgery safer. In the future, there is a possibility of delivering chemotherapy directly into the tumor, and trials in various centers across the globe are underway.

Role Of Neuro Intervention In The Management Of Chronic Subdural Hematoma

Chronic subdural hematomas are relatively common in the elderly population, particularly those individuals who are on blood thinners due to heart issues. In India, with a growing aging population, the incidence and number of patients with chronic subdural hematomas are increasing.

By using these techniques, selected patients can be managed by blocking the blood supply to the membrane, which leaks, leading to blood supply formation. This is a very recent advancement that helps many elderly high-risk patients avoid open surgery.

“Neurointerv” nation changed my life! I had a brain issue, and thanks to this innovative treatment, I recovered quickly without any major surgery. Also, Dr. Vikas Gupta was fantastic and explained everything so well. Now, I’m back to I’mnormal life and grateful for their expertise and care,” a patient “f Dr. Vikas mentioned.

Another patient expressed, “As someone who is afraid of surgeries, Neurointervention was a blessing. The procedure was so simple, and recovery was a breeze. The team made me feel comfortable throughout. I can’t thank them enough for their professionalism and for making my brain health journey smooth.”

How much does Interventional Neuro-Radiology cost in India?

The cost of a Diagnostic cerebral DSA in India varies from around rupees ₹50000 to ₹70000. On average, procedures like aneurysm coiling or embolization range from 350000  to ₹5,00,000. More complex interventions such as brain arteriovenous malformations (AVM) or tumor embolization can cost between ₹3,00,000 to ₹8,00,000 ($4,050 to $10,800).

What are the Challenges and Ongoing Advancements?

The challenges in INR involve occasional hurdles. Sometimes, despite all efforts, there might be minor problems after the treatment, but these are rare. However, scientists and doctors are constantly working on new and better ways to make INR even more precise and safe. Just like how new gadgets get upgrades, INR procedures keep getting better to ensure they’re even more effective and safer for everyone.

Conclusion

Neurointervention is a revolutionary approach to brain healthcare. Its minimally invasive procedures, diagnostic accuracy, and targeted treatments significantly improve patient outcomes. Neurointervention’s Neurointervention’s brain issues early, managing abnormalities, treating strokes, and handling brain tumors, offering patients quicker recoveries without extensive surgeries. Despite challenges, ongoing advancements aim to refine techniques for safer and more effective interventions. Like a precise toolset for brain care, INR continues to transform treatment methods, enhancing brain health globally.

FAQs

1. What are the potential risks after undergoing INR treatment?

Complications do occur as with any other surgical procedure, but with meticulous planning and execution, the risk of complication is minimized.

2. Are there alternative treatments to INR for brain issues?

Yes, conventional surgeries or medication therapies exist.

3. Can INR be performed on all types of brain conditions?

Neurointervention is indicated for conditions of the brain affecting brain circulation. A specialist assesses its suitability for specific situations.

4. How long does recovery take after an INR procedure?

Recovery periods are usually shorter than traditional surgeries, ranging from a few days to weeks, depending on the procedure.

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