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100 E Campus View Blvd
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Columbus, OH 43235
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3525 Olentangy River Rd
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Columbus, OH 43214
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7651 Stagers Loop
Delaware, OH 43015
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NeuroInterventional Surgery

Interventional NeuroRadiology or endovascular surgical neuroradiology as a specialty has undergone rapid evolution during its short existence. Originally developed in the 1980's by radiologists and neurological surgeons, INR is made possible by dramatic advances in computer technology and state-of-the-art equipment. Essentially, interventional neuroradiology therapies are accomplished through microcatheters inserted in the groin area and, under X-ray guidance, threaded through the blood vessels leading into the brain. Interventional neuroradiologists currently employ minimally invasive procedures to accomplish a wide variety of treatments including: stroke treatment by delivering clot-busting drugs directly to the site of the blockage; aneurysm therapy by inserting platinum coils into the aneurysm bulge to prevent clotting and rupture; and spinal treatments by injecting cement into a fractured vertebra in order to reinforce the bone.

Riverside Radiology Associates proudly offers all Interventional NeuroRadiology services at Riverside Methodist Hospital in Columbus, Ohio. All procedures are performed in a special NeuroInterventional Radiology Suite, which is set up much like an Operating Room. Patients can meet with our physicians prior to any procedures and also for routine follow up in the Riverside Interventional Consultants Office.

Brain Aneurysm Coiling (Back To Top)

A brain aneurysm (or cerebral aneurysm) is an outpouching of a cerebral artery. Let untreated, the aneurym may rupture causing a subarachnoid hemorrhage. This may lead to numerous disabilities and possible death.

The treatment of an aneurysm is often determined by its size and location. Traditional surgery is performed by a neurosurgeon, however, the patient may also have the option to select endovascular treatment or "coiling," a less invasive option with fewer risks and possibly quicker recovery. In some cases, Brain Aneuysm Coiling is more of a benefit to the patient than traditional surgery.

As in other endovascular treatments, a catheter is inserted in the groin area and threaded through the vessels to the site of the aneurysm. Detachable platinum coils are then dispensed through the catheter and placed carefully inside the aneurysm. The number of coils used depends on the size of the aneurysm. Typically, patients are under general anesthesia for this procedure.

As an aneurysm is really a "ballooning" in a weakened area of a vessel wall, the goal of "coiling" is to pack the aneurysm tightly to close off blood flow into the aneurysm thereby preventing its rupture, but not to block off the "normal" blood flow to the brain. Occasionally, it is necessary to add more coils at a later time to complete treatment.

Certain aneurysms may be treated by blocking the artery from which the aneurysm arises using coils or detachable balloons. Additional new methods of aneurysm treatment are in development.

Hospitalization time varies from patient to patient. A 1 or 2-day hospitalization may be possible for certain patients who have not had a hemorrhage, but patients who have had a recent brain hemorrhage from a ruptured aneurysm may expect to be hospitalized at least 10-14 days minimum. A follow-up x-ray, MR scan, or an angiogram may be performed to evaluate the position of the coils.

Patients may be placed on a blood thinner such as aspirin after the procedure, which may be continued after discharge.

Brain Arteriovenous Malformations (AVMs) (Back To Top)

Arteriovenous malformations (AVMs) are typically diagnosed by a CT scan or MRI upon presentation of symptoms that may include seizures, headache or stroke-like episodes. Once an AVM is confirmed, an angiogram or arteriogram is performed to identify the vessels involved in the malformation. Angiography is the only test currently available that provides sufficiently detailed information useful in planning and implementing therapy of most AVMs.

There are three major treatment methods that may be useful either alone or in combination to treat an AVM. The specific treatment for an individual is based on the patient's history, symptoms, and anatomy of the AVM including its size, feeding arteries, draining veins, and location within the brain. Treatments include: endovascular embolization (closure of the AVM from within the blood vessels), open surgical removal of the AVM, radiosurgery or a combination of techniques.

Open surgical treatment involves removing a portion of the skull so that surgical instruments can be inserted to remove the AVM. Surgical treatment is often performed after embolization has closed portions of the AVM. The combination of embolization followed by surgical resection is frequently safer than surgical resection alone in treating an AVM.

Radiosurgery is a technique which uses focused beams of radiation to treat particular AVMs that are sufficiently small and located in appropriate areas of the brain. Despite the name, no opening of the skull is required. Instead, the radiation causes scarring in blood vessels of the AVM, thereby eliminating it. After treating the AVM with radiosurgery, a period of two to three years is required for the full effect of the treatment to be determined. In over 80% of cases where the AVM is sufficiently small, there is complete obliteration of the AVM.

Embolization is an endovascular technique (performed from within the blood vessels) to block the vessels of the AVM. In this procedure, a small catheter is threaded from the groin directly into the AVM vessels within the brain. Under X-ray guidance, material is injected through the catheter to permanently block and close off the vessels of the AVM. Materials used might include particles, small platinum coils, and/or liquid embolic agents similar to glue.

Embolization of an AVM is usually performed before treatment by either surgery or radiosurgery. Embolization is often able to decrease the size of the AVM making the surgery or radiosurgery much safer than would otherwise be the case. However, the blood flow from certain AVM's may be totally blocked by embolization techniques, and no further therapy may be required.

Cartoid-Cavernous Fistulae (Back To Top)

A carotid-cavernous fistula is a rare complication that involves a communication between the high pressure internal carotid artery and the low venous pressure flow of the cavernous sinus. The internal carotid passes through the cavernous sinus. Typically this fistula is a result of a blunt trauma or a ruptured aneurysm.

Because of their location, carotid-cavernous fistulae are difficult to treat surgically. Instead, endovascular treatments may be employed by placing a catheter into the blood vessels and injecting materials to block off the fistula and/or the vein. Sometimes, the same method is utilized so that the carotid artery itself may be blocked off to close the fistula. If this is necessary, tests are performed first to make sure that there is enough blood flow to the brain from the other arteries.

Cerebral Angiography (Back To Top)

Angiography is an x-ray exam of the arteries and veins used to diagnose blood vessel problems and blockages which involves the use of a catheter inserted into an artery. The catheter is inserted through a small nick in the skin that is about the size of a pencil tip, a contrast agent or x-ray dye is then injected to increase the visibility of the blood vessels on the x-ray image.

One of the more common uses of angiogram is to determine if there is a blockage or narrowing in the blood vessels that interferes with the normal flow of blood through the body. Often times, the interventional radiologist can treat the blocked blood vessel with angioplasty and thrombolysis techniques. Other reasons for performing angiograms include aneurysms, cerebral vascular disease such as stroke or bleeding in the brain, blood vessel malformations or to diagnose medical conditions that are not resolved with other tests. Angiograms can also be used by surgeons to assist in planning an operation or choosing the appropriate surgical procedure.

Dural Ateriovenous Fistulae (Back To Top)

Dural arteriovenous fistulae are abnormal connections between arteries in the head and the large veins that are found in the covering of the brain (dural sinuses) which are responsible for draining the brain. With this particular condition, there is a direct connection between the arteries and the sinus without any normal capillary mesh between the two.

These fistulae can result from trauma, infections (such as sinus infections or mastoiditis), or from clotting of the vein. In the latter case, the fistula forms when the body tries to reopen the vein. The most dangerous complication of a fistula is rupture of the vein, resulting in hemorrhage in or around the brain.

The treatment for a dural fistula depends on the vessels involved. Surgery or radiation therapy may be recommended. Often, these fistulae are treated through endovascular methods by placing a catheter into the blood vessels and injecting materials to block off the vessels, a procedure called embolization. Blockage of arteries, vein (sinus), or both may be needed. Multiple treatments may be needed to close the fistula.

Embolization for Bleeding (Nosebleeds) (Back To Top)

Nosebleeds are very common; however only 6% will need medical treatment. People who are older, history of high blood pressure and in cases of injury to the nose or face are at a higher risk for nose bleeds that require medical attention. Most nosebleeds can be treated with local pressure and nasal decongestants. Nasal packing (and blood transfusion) may be needed if the bleeding does not stop.

If these treatments do not work and the bleeding continues, the physician can possibly identify the site of bleeding by examination and cauterize the vessel. If the bleeding site cannot be found or does not respond to these treatments, or if the bleeding is too severe, then a procedure to block off the bleeding vessels may be required. In this case, a catheter is inserted into an artery at the groin, and is threaded through the vessels leading up to the ones supplying the nose. Once at the site, material is injected through the catheter to plug the bleeding vessel, allowing it to clot and heal.

Embolization of Vascular Lesions (Back To Top)

Lesions that can be treated in a similar manner as Vascular Tumors include:

  • Traumatic Vascular Lesions
  • Spinal Vascular Malformations
  • Extracranial and Paraspinal Vascular Malformations

Embolization of Vascular Tumors (Back To Top)

Vascular Tumors can cause neurological problems. Because of the tumor's location, size or growth, treatment may be necessary. Vascular masses or lesions can be removed surgically; however, when they are large, or have a large blood supply, surgical removal is riskier. When this is the case, they may be treated through endovascula methods by placiong a catheter into the blood vessels supplying the tumor and injecting materials to block off the blood supply to the tumor. This procedure, called embolization, is usually perfomred within a few days prior to the surgery.

Tumors that can be treated by the Interventional NeuroRadiologist is this manner include:

  • Meningiomas
  • Paragangliomas
  • Juvenile Nasopharyngeal Angiofibromas
  • Head and Neck Tumors
  • Vertebral Body Tumors

Stroke Therapy (Back To Top)

Stroke is the third leading cause of death in this country and the leading cause of adult disability. A stroke occurs when a section of the brain is deprived of blood supply which carries oxygen to the brain.

Symptoms:
The most common symptoms of a stroke are: sudden numbness or weakness in the face, arm and/or leg, particularly on one side of the body; sudden confusion, difficulty speaking or comprehending speech; sudden problems seeing including double or blurred vision, partial blindness; dizziness, difficulty walking, loss of balance and coordination; sudden onset of a severe, unexplained headache. If you experience any of these symptoms, immediately call 911 for emergency medical care.

Diagnosis:
There are a number of types of diagnostic exams that can be performed to determine if a stroke has occurred or someone is at risk for a stroke. A CT scan is typically the first test performed to diagnose a stroke. This exam can confirm a stroke and determine if the cause of the stroke is hemorrhage in the brain. An MRI may be performed to further localize the location of the stroke and determine the source. It may be able to identify the area deprived of blood flow and help determine treatment options. Angiography is an x-ray exam in which a contrast agent or dye is injected into a vein or artery to highlight the blood vessel. This exam allows interventionalists to define the exact location; special catheters can then be directed to the location to administer treatment. Doppler ultrasound may also be used to pinpoint blockage as well as MRA (Magnetic Resonance Angiography).

Treatment:

To Dissolve Clots:
If a stroke has been caused by blood clots, tPA or tissue plasminogen activator (a clot-dissolving drug) is frequently used to break-up or reduce the size of blood clots to the brain immediately following a stroke. The drug is typically administered through a special catheter within three to six hours after a stroke.

To Open Narrowed Carotid Arteries:
If a stroke is a result of narrowed carotid arteries, follow-up treatment involves procedures to open the narrowed arteries to prevent further strokes. A surgical treatment, carotid endarterectomy can be performed to scrape the plaque from the artery wall. Intracranial and Extracrnial Angioplasty is another procedure that interventional radiologists use to treat atherosclerosis ("hardening of the arteries") in the blood vessels of the head and neck. This "balloon" procedure is utilized to open up constricted blood vessels to increase blood flow and minimize blockage which leads to a stroke. The procedure is done with a small balloon catheter inserted, usually through the groin, which can be guided to the narrowing and inflated to open the blockage. In some instances a stent, or a small metal tube, is put in place that assists in holding the vessel open.

To Treat Hemorrhages:
When a stroke is caused by bleeding into the brain (hemorrhagic stroke) the treatment is different than that used for blood clots. Typically, a surgical clip has been the procedure used to treat hemorrhages. The use of coil embolization procedures performed by interventional neuroradiologists is increasing. In an embolization, an embolizing agent is injected via a catheter under x-ray guidance at the site of the ruptured blood vessel. The agent clots or closes off the bleeding blood vessel. Another procedure that may be used to stop bleeding or rupture is GCD coil insertion. The GDC is used to pack the vessel tightly to close off blood flow from the site. The coil is inserted via catheter.

Vasospasm (Back To Top)

Vasospasm is the narrowing of the vessels that supply blood to the brain that occurs after bleed from a cerebral aneurysm. The spasm can prevent enough blood from reaching the brain and may lead to stroke. A catheter is placed into an artery and medication is infused to dilate the arteries More than one artery may need to be treated and it is not uncommon that the procedure may need to be repeated over the course of time.

Vertebroplasty (Back To Top)

Vertebroplasty is a treatment procedure performed by interventional radiologists which stabilizes broken bones in the spine caused by osteoporosis. A needle is inserted through the skin, into the crushed vertebrae, where surgical bone cement called poly-methymethacrylate is injected into the bone to stabilize it. More than one crushed vertebrae can be treated in a single procedure. Surgery is not required, because the radiologist is can guide the needle to the exact location via special x-ray equipment. The procedure stops the pain caused by bone rubbing against bone. Most patients experience immediate pain relief.

Additional Procedures (Back To Top)

In addition to the procedures outlined above, the Riverside Radiology and Interventional Associates Interventional NeuroRadiologists perform a number of additional procedures to address vascular diseases. They consult with your referring physicians to determine the best treatment options for your condition.

  • Intra-arterial Chemotherapy for Brain Tumors and Head and Neck Tumors
  • Permanent Vascular Occlusion
  • Petrosal Sinus Sampling
  • Temporary Test Occlusion of Vessels
  • WADA Test for Brain Function

For further information, please visit www.asitn.org

Carotid/Cerebral Stenting (Back To Top)

Athersclerosis is hardening of the arteries. This can cause narrowing and blockage of blood vessels. When this occurs, blood flow to part of the brain can be threatened and stroke can occur.

In 2004 a minimally invasive treatment for carotid atherosclerosis called carotid stenting received FDA approval. This procedure is performed by opening the artery with a small tube and then inflating a balloon catheter to press the plaque into the sides of the artery wall. Similar to angioplasty, this procedure is also utilized in the heart. Subsequently, a stent, or supportive tube, is then placed in the artery to cover the plaque and help keep the vessel open.

In deciding between surgery and stenting to treat carotid atherosclerosis, doctors consider the patient's overall health condition. In cases where a patient is symptomatic and at high risk for surgery (experiencing poor health in general, manifesting a heart condition or experiencing a previous stroke), angioplasty and stenting has been proven in a recent trial to be at least as effective as surgery. If the carotid artery is minimally constricted due to blockage, medical treatment may be recommended. However, if significant blockage is present, surgery (endarterectomy) is usually performed. Designed to remove the plaque causing the constriction which in turn allows the blood to flow more freely, endarterectomy is becoming increasingly more common, and is often referred to as "the gold standard" treatment for carotid atherosclerosis. Endarterectomy is especially recommended for patients who have significant blockage.

In cases where a narrowing or stenosis is present in the vertebral artery, angioplasty and stenting are usually performed.

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Riverside Radiology and Interventional Associates, Inc. continues to expand its capabilities positioning itself to be on the forefront of imaging capabilities and technology advancements. RRIA continues to seek new ways to utilize imaging technology to enhance the lives of those it serves. Through the benefits of technology RRIA has the opportunity daily to touch lives in ways only imagined a short decade ago. It is those goals of changing and touching a life at each moment, of each day that keeps RRIA firmly focused on providing nationally recognized imaging service to patients throughout Ohio.