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Vascular Neurosurgery: Technological Innovation Where Every Minute Counts

Kimon Bekelis, MD (left)
Director of the Stroke & Brain Aneurysm Center and co-director of the Neuro ICU at Good Samaritan Hospital Medical Center
Chairman, Neurointerventional Services at Catholic Health Services of Long Island
West Islip, NY

Clemens M. Schirmer, MD, PhD, FAANS, FAHA (right)
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, PA

Cerebrovascular disorders often come with grave consequences. Treatment of these disorders has undergone a dramatic transformation and technological advancements in recent years. Since the time of Walter E. Dandy, MD, the specialty of neurosurgery has attracted some of the most technically skilled neurosurgeons, determined to change the course cerebrovascular disease through complex surgical approaches. Technological breakthroughs including advances in imaging and devices, particularly minimally-invasive techniques, have changed the face of the specialty forever. These developments broadened the tools at the disposal of a modern neurovascular neurosurgeon to include minimally invasive approaches to treat the majority of cerebrovascular disease and stroke. With that came a revolution in patient satisfaction, morbidity and length of stay for this population.

Cerebrovascular neurosurgeons treat some of the most challenging diseases of the central nervous system, often under tremendous time pressure. These include:

  • Ischemic stroke. This is the leading cause of adult disability in the United States with an annual cost of $34 billion. All evidence suggests a stroke epidemic with increasing incidence every year. Until very recently, severe strokes had limited treatment options and were associated with almost certain death or disability. Fortunately, we are now able to offer to some patients what has been described as the most effective intervention in medicine. Today, endovascular neurosurgeons and other practitioners use minimally invasive techniques through a needle-stick in the groin or wrist to remove blood clots from the brain and reverse the impact of these strokes in minutes.
  • Cerebral aneurysms. About six million people in the United States have a brain aneurysm. Ruptured aneurysms are fatal or disabling in over 50 percent of the patients. Minimally invasive approaches, such as coiling, stenting and flow diversion have supplemented traditional aneurysm clipping to change the face of this disease forever.
  • Carotid atherosclerosis. This is the leading surgically preventable cause of stroke. Neurosurgeons employ multiple tools such as carotid endarterectomy, or minimally invasive stenting techniques, to open the blood vessels of the neck and prevent devastating strokes.
  • Other neurovascular disorders. These include diseases and problems like arteriovenous malformations, intracerebral hemorrhage and other vascular disorders.

The decisions made by these professionals profoundly impact a patient’s functional independence and quality of life. The outcomes of these diseases have dramatically improved in recent years due to technological advances but also due to breakthroughs in innovations in the complex care of these sickest of patients. Neurosurgeons have been integrally involved with some of the major developments in this field and continue to move progress forward, serving our patients and the public. At the same time, there are plenty of opportunities for advances and progress left to address.

Journey with us throughout May (and part of June) as we highlight many vascular neurosurgical stories — of patients, of those who have worked to transform the field, of new innovative approaches to old problems and of the ongoing work to improve patient care. We encourage everyone to join the discussion online by using the hashtag #VascularNeurosurgery.

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