The Role of Neurosurgeons in Neurointerventional Surgery

Abstract

Objective: Although the endovascular technique represents an important, minimally invasive approach to cerebrovascular diseases, only a few neurosurgeons are trained in both endovascular and surgical management of intracranial vascular pathologies. Our aim was to emphasize the importance of the endovascular approach in neurosurgery by analysing the cerebral digital subtraction angiography findings in our patients. Materials and Methods: We analysed 207 patients who underwent cerebral angiography between February 2011 and June 2014. They had previously been diagnosed with cerebral vascular pathology including aneurysm, arteriovenous malformation (AVM), carotid cavernous fistula, vasculitis and Moyamoya disease according to computed tomographic angiography/magnetic resonance angiography findings. Demographic data, indications for cerebral angiography, endovascular and surgical treatments, complications and results were analyzed. Results: This study included a total of 207 patients (108 males and 99 females) with a mean age of 57.43±11.14 (17-83) years. A total of 234 selective angiographies were performed. The indications for procedures were as follows: cerebral aneurysm (n=118, 57%), Moyamoya disease (n=3, 1.4%), AVM (n=13, 6.3%), carotid cavernous fistula (n=2, 1%), and intracranial vascular stenosis (n=2, 1%). No pathology was found in 69 patients (33.3%). Conclusion: Cerebral angiography is important not only in the diagnosis but also in the treatment of cerebrovascular diseases. Neurointerventional surgery is a safe and minimally invasive treatment option based on meticulous protocols, however, it has not been included in the neurosurgery residency program yet. Developing training programs for endovascular neurosurgeons provididing comprehensive patient care should be considered.