What Is Interventional Neurology?

Interventional technology, together with internal medical technology and surgical technology, are collectively referred to as the three major medical technologies; compared to the latter two, it is a young technology that is independent of, but intersects with, and develops in synergy with them. Interventional technology is divided into three major categories of cardiac intervention, peripheral intervention and neuro-intervention according to different professional fields.

Basic Information

Chinese name

Nerve intervention

Related diseases

Cerebrovascular disease, spinal vascular disease

Zhanglinfen Road

Neurology

Indication

Ischemic or hemorrhagic cerebrovascular disease, cerebral aneurysm

Advantage

No scarring, few contraindications, fast, etc.

Application of nerve intervention technology

Nerve interventional technology is mainly used to treat vascular diseases of the brain and spinal cord. It is also involved in the treatment of diseases such as brain tumors and spinal tumors.

1. Ischemic cerebrovascular disease: cerebral artery stenosis (Figure 2), acute or chronic cerebral artery occlusion (Figure 3), intracranial venous sinus thrombosis, etc.

(Figure 2 Stent treatment for severe carotid stenosis)

(Figure 3 Carotid artery occlusion and stent lumen shaping)

2. Hemorrhagic cerebrovascular disease: cerebral aneurysm (Figure 4), cerebral arteriovenous malformation, arteriovenous fistula, spinal cord-spine vascular malformation, etc.

(Figure 4 interventional treatment of cerebral aneurysm)

3. Brain-spinal spine tumors: preoperative angiographic evaluation and embolization of blood-rich tumors, intra-arterial superselective chemotherapy for malignant brain tumors, etc.

Nerve interventional technology

Digital subtraction angiography is still the "gold standard" for the diagnosis of cerebral and spinal vascular diseases. It is usually performed through the femoral artery (Figure 5), and can be done under local anesthesia except for children who cannot cooperate, mental or mental disorders. After injecting a small amount of anesthetic in the groin area, puncture the femoral artery and place a vascular sheath, and then use selective intubation technology to complete the contrast injection of the cerebral or spinal blood vessels. The doctor can see the dynamic imaging of the patient's blood vessels on the monitor. Patients need to be hospitalized for angiography. Generally, skin preparation for the groin area is performed before surgery, and water is not fasted before surgery. Depending on the patient's condition, the doctor will selectively infuse some patients to reduce the side effects of the contrast agent. If there is no discomfort after angiography, the diet can be appropriately restored. The lower extremity of the puncture side is generally braked for 6-8 hours. If a vascular closure device or a compression device is used, the patient can move in bed after 4-6 hours.

(Figure 5 Femoral artery puncture during interventional surgery)

For patients undergoing interventional treatment, there will be different treatment measures depending on the condition and the treatment performed, such as: complex surgery requiring general anesthesia; arterial stent placement, aspirin and other anti-surgery medications for a period of time before and after surgery Platelet drugs, and other diseases that require a period of anticoagulant therapy (such as subcutaneous injection of low molecular weight heparin, oral warfarin, dabigatran, etc.). The patient must cooperate with the doctor to receive treatment, and can not stop and add medicine at will. Patients after interventional treatment should also be regularly followed up according to the doctor's requirements.

The advantages of neurointervention technology

Compared with traditional open surgery, neuro interventional surgery has the following advantages:

1. Minimally invasive surgery and non-scarring nerve intervention technique avoid tissue trauma caused by craniotomy, with fast postoperative recovery and fewer complications, so it is easy to be accepted by patients; American Stroke Association and Heart Association 2012 In the guidelines, it is clear that the recommended choice of interventional surgery for ruptured aneurysms that are suitable for both craniotomy and interventional treatment is to affirm its advantages. The nerve intervention surgery mostly adopts the femoral artery approach. Only 1-2mm wounds are required during surgery (Figure 6). The surgical approach is concealed, leaving unsightly scars on the body surface and affecting aesthetics.

(Figure 6 Small inguinal incision after interventional surgery)

2. Wide indications, absolute contraindications are common in elderly with cerebrovascular disease, such as the peak age of cerebral thrombosis is around 65 years old, and often accompanied by other diseases, such as hypertension, diabetes, heart disease, hyperlipidemia, etc. Patients were poorly tolerated, including physical conditions and psychological factors. Nerve interventional surgery has less trauma, shorter time, less damage to patients, less pain, and lower risk; those who cannot tolerate open surgery or general anesthesia due to comorbidities are a good choice. Interventional surgery adopts the intravascular approach, which avoids the surgical restrictions caused by the diseased area, such as high or very low carotid stenosis, which is difficult to expose, and the intervention can be easily performed; multiple intracranial aneurysms can be performed once Complete; vascular lesions in the deep brain or important functional areas, such as arteriovenous malformations of the thalamus and brainstem, are often difficult or impossible to perform, and interventional surgery can often complete the treatment.

3. Fast and rapid nerve intervention surgery can be implemented quickly in emergency situations, such as interventional treatment of acute cerebral thrombosis. Completing the femoral artery puncture and inserting the catheter into the diseased blood vessel can often be completed in a few minutes or more than ten minutes. The recanalization of the blood vessel can be completed in the shortest time to save brain tissue.

4. Complementary with surgery, organic combination such as: large cerebral arteriovenous malformations, direct surgical resection of large trauma, bleeding, and high risk, you can first partially embolize, reduce volume, control blood flow, and have complete control of surgical resection. . For another example, intracranial blood-rich tumors, intraoperative bleeding are not well controlled, often cannot be removed or cannot be completely removed, and the use of preoperative embolization will greatly improve the cure rate and safety. In recent years, compound surgery (also known as hybrid surgery) has been highly regarded in the treatment of vascular diseases, which is the result of the organic combination of neural intervention and open surgery.

Neuro-Interventional Techniques Risks and Side Effects

Nerve interventional surgery is easy to be misunderstood as "minor surgery" or no risk due to the small trauma and fast recovery after surgery. This is very wrong. Nerve intervention surgery is less invasive because it treats the disease through the physiological lumen (intravascular), but it is still risky to perform intravascular operations, such as rupture and blockage of blood vessels, which can cause intracranial hemorrhage or cerebral infarction, causing serious as a result of. In the classification of surgical level, cerebral angiography is classified as a third-level operation, and the general interventional treatment is a fourth-level operation (the highest level), which shows that it is not a minor operation. Neuro-intervention doctors often need to have a deep foundation in neurology and neuroanatomy, as well as keen image discrimination and skilled catheter manipulation, otherwise "minor surgery" will cause "big trouble".

What is most worried about during nerve intervention surgery is the rupture or blockage of cerebral blood vessels caused by various reasons during and after surgery. The doctor will analyze and explain to the patient or family members before surgery. In addition, there are some other issues that need attention, such as hematoma at the puncture site, kidney damage caused by contrast agents, and side effects caused by radiation.

In addition, although nerve interventional surgery has many advantages and is very promising, it is currently limited by some conditions and there are some shortcomings that need to be gradually overcome in development. For example, the recurrence rate of intracranial aneurysms after embolization is higher than that after clamping. Fortunately, some well-performing intracranial stents and modified spring coils are gradually overcoming this problem.