Some of the most serious problems in the brain start in its blood vessels: a weak spot that balloons into an aneurysm, a tangle of abnormal vessels, or a clot that cuts off the blood supply. Endovascular neurointervention treats many of these from inside the blood vessel itself, so the skull does not need to be opened.
Whether this is the right route depends on the type of problem, its size and position, and the patient's condition. Some cases are better treated with open surgery, and some only need to be watched.
With blood vessel problems in the brain, getting the diagnosis and the plan right matters as much as the procedure itself.
Dr. Gaurav Sharma sees patients with aneurysms, brain bleeds and other neurovascular problems, and takes time to explain the findings and the choices to them and their families.
Instead of reaching the problem through an opening in the skull, a fine catheter travels through the arteries from the groin or the wrist.
Dr. Sharma's work also includes open aneurysm surgery, skull base and endoscopic procedures, so both routes can be weighed up for each patient.
Neurovascular problems show up in different ways. Some patients arrive with a sudden severe headache or stroke symptoms; others find out about an aneurysm after a scan done for something else. Before any decision, the history, the examination and detailed imaging, often a CT or catheter angiogram, are looked at together.
The size, shape and location of an aneurysm or malformation, along with the patient's age and other health issues, decide whether it should be treated, by which method, or simply monitored. The likely benefits and risks of each option are explained before anything is chosen.
What is endovascular neurosurgery? It is a way of treating problems in the brain's blood vessels from inside the vessel. A thin tube (catheter) is passed from an artery in the groin or wrist up to the brain under X-ray guidance, so the skull does not need to be opened.
Most strokes are caused by a clot blocking an artery in the brain (ischaemic stroke). Depending on how much time has passed since the symptoms began, treatment may include a clot-dissolving medicine and, for a large blocked artery, mechanical thrombectomy, where the clot is pulled out through a catheter. Both work best when started early, so the sooner a person with stroke symptoms reaches a hospital with stroke facilities, the more options there are. Learn the warning signs in our article on brain stroke symptoms (BE FAST).
An aneurysm is a weak, ballooned area in the wall of a brain artery. If it bursts, it causes bleeding around the brain (subarachnoid haemorrhage). There are two main treatments. In coiling, soft platinum coils are placed inside the aneurysm through a catheter. In clipping, the aneurysm is closed from outside with a small metal clip during open surgery. The choice depends on the aneurysm's shape, size and location, and the patient's condition. Small aneurysms found by chance do not always need treatment and may be followed with scans.
Bleeding inside the brain can be caused by high blood pressure, a burst aneurysm, an arteriovenous malformation (AVM) or an injury. Some bleeds are managed in the ICU with blood pressure control and close monitoring. Others need surgery to remove the clot or relieve pressure, or endovascular treatment of the bleeding vessel.
An AVM is an abnormal tangle of blood vessels in the brain. It may be found after a bleed or a seizure, or by chance on a scan. Treatment options include embolisation, surgery or radiosurgery, alone or in combination, and are planned after detailed angiography.
Coiling closes the aneurysm from inside the blood vessel using coils placed through a catheter, without opening the skull. Clipping closes it from outside with a small clip during open surgery. The choice depends on the aneurysm and the patient.
It is a procedure in which a large clot blocking a brain artery is removed through a catheter passed from the groin or wrist. It is used for selected stroke patients and works best when done early.
A sudden, very severe headache, vomiting, neck stiffness, drowsiness, confusion, a seizure, or sudden weakness or difficulty speaking. These need emergency care straight away.
Yes. Long-standing, poorly controlled blood pressure is one of the most common causes of bleeding inside the brain. Regular BP checks and taking medicines as prescribed lower the risk.
No. Small aneurysms found by chance may only need monitoring with periodic scans. The decision depends on the size, shape, location and the patient's other risk factors.
