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Endovascular Neurosurgery: Current and Emerging Technologies

Endovascular neurosurgery is an emerging field that allows the surgeon to treat many neurological conditions with minimally invasive techniques, when traditionally these conditions required complex open surgeries. These conditions include cerebrovascular diseases, such as stroke, aneurysms, tumors and arteriovenous malformations (AVMs). Sometimes a case that is deemed untreatable using conventional surgery may be treatable using endovascular techniques. Rather than accessing the brain from the outside using a knife and drill, endovascular techniques allow these diseases to be treated from the inside through blood vessels that naturally lead to the brain from the femoral artery in the leg. In most cases, this type of treatment does not carry the same risk and extended recovery when compared to a craniotomy, or open brain surgery.

With an estimated one in every 50 people in the U.S. living with a brain aneurysm, viable endovascular procedures to repair or remove aneurysms are imperative. The neurosurgeon inserts a tiny catheter through the patient’s groin and maneuvers it to the aneurysm. The aneurysm is then packed with platinum coils or bypassed by a stent, called a Pipeline, essentially creating a new vessel and shutting off the blood supply to the aneurysm. “The Pipeline is a microcatheter-delivered stent that is able to divert blood away from an aneurysm,” said Shervin R. Dashti, M.D., Ph.D. “It’s a quantum leap in aneurysm treatment. The aneurysm gets no blood and essentially closes off.”

Pipeline and coiling are minimally invasive and often safer than traditional surgery. Plus they result in shorter hospital stays and recovery time, as well as fewer complications. Endovascular techniques also are helpful in embolizing vascular tumors in the brain, where operating can pose serious challenges to control blood loss. These techniques can block vessels that supply blood to a tumor while the surgeon works to remove the tumor.

The endovascular neurosurgeons at Norton Neuroscience Institute also are providing more comprehensive care for stroke patients. Interventional procedures to treat ischemic stroke are now available in our community. “To treat ischemic stroke we have to dissolve or remove the clot that is preventing blood from reaching an area of the brain,” said Tom L. Yao, M.D. “We can use small catheters to infuse thrombolytics directly into the clot to dissolve it or use new devices, such as the Solitaire Revascularization Device, to remove clots and restore blood flow.”

The Solitaire device is the latest breakthrough in clot removal. This stent-like device widens the interior walls of the artery to re-establish blood flow in the brain. The clot then seeps into the mesh of the stent and, after several minutes, the device and clot are removed. “Traditionally many procedures to treat these conditions were done with craniotomy or large open surgery,” Dr. Yao said. “Now they are minimally invasive, and many patients go home the next day.”

Drs. Dashti and Yao are experienced in the latest techniques in endovascular therapy, making some of these emerging technologies available for the first time to patients in Greater Louisville. In addition to performing these techniques, Drs. Dashti and Yao have completed extensive training in and performed traditional open neurosurgeries. It is important to keep in mind that in some cases traditional surgery is indicated over endovascular techniques.

Contact information

To schedule an appointment at any of these locations, call (888) 4-U-NORTON.

Norton Neuroscience Institute – Audubon
Norton Medical Plaza East – Audubon, Suite 330
3 Audubon Plaza Drive
Louisville, KY 40217
(502) 583-1697

Norton Neuroscience Institute – Downtown
Gray Street Medical Building, Suite 1105
210 E. Gray St.
Louisville, KY 40202
(502) 583-1697

Norton Neurology Services – Suburban
Norton Medical Plaza II – Suburban, Suite 310
3991 Dutchmans Lane
(502) 899-6782

Norton Neurology Services – Downtown
Gray Street Medical Building, Suite 1003
210 E. Gray St.
Louisville, KY 40202
(502) 629-2602

Norton Neuroscience Institute – Brownsboro
Norton Medical Plaza – Brownsboro, Suite 205
4950 Norton Healthcare Blvd.
Louisville, KY 40241
(502) 394-6390

Norton Neurology Services – Audubon
Norton Medical Plaza East – Audubon
3 Audubon Plaza Drive, LL2
Louisville, KY 40217
(502) 636-4940

Norton Neurology Services – Brownsboro
Norton Medical Plaza – Brownsboro, Suite 201
4950 Norton Healthcare Blvd.
Louisville, KY 40241
(502) 394-6460


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