Cerebrovascular Surgery
Cerebrovascular surgery is a specialized field of neurosurgery dedicated to treating blood vessel disorders of the brain and spinal cord. These conditions often involve restricted blood flow (ischemia) or weakened blood vessels prone to rupturing and causing intracranial hemorrhage.
Core Vascular Conditions Treated
Cerebral Aneurysms: Weakened, bulging arterial walls that risk rupturing and causing subarachnoid hemorrhage.
Arteriovenous Malformations (AVMs): Congenital tangles of abnormal arteries and veins directly connected without an intervening capillary bed, disrupting blood flow and increasing bleed risk.
Carotid Artery Stenosis: Narrowing of the carotid arteries due to atherosclerotic plaque build-up, significantly raising the risk of ischemic stroke.
Cavernous Malformations (Cavernomas): Low-pressure clusters of dilated capillary-like vessels prone to slow, recurring micro-bleeds.
Moyamoya Disease: A progressive occlusive cerebrovascular disorder leading to arterial narrowing at the skull base and compensatory, fragile vessel networks.
Open Surgical vs. Endovascular Treatment Approaches
Cerebrovascular conditions are managed using two primary paradigms: traditional open microsurgery and minimally invasive endovascular approaches.
| Category | Open Microsurgery | Endovascular Approach |
| Primary Technique | Open craniotomy with direct microscopic visualization | Percutaneous catheter navigation through femoral or radial artery |
| Common Procedures | Surgical Clipping, AVM Resection, EC-IC Bypass, Carotid Endarterectomy (CEA) | Endovascular Coiling, Stenting, Flow Diverters, Thrombectomy, Embolization |
| Invasiveness | Requires skull flap removal | Minimally invasive via blood vessels |
| Hospital Stay | 3 – 7+ days | 1 – 3 days |
| Primary Advantage | Complete anatomical cure and lower long-term recurrence rates | No craniotomy needed; faster immediate recovery |
Procedural Workflow (Emergency Ischemic/Hemorrhagic Intervention)
Rapid Assessment & Angiography
Non-contrast CT, CT Angiography (CTA), or Digital Subtraction Angiography (DSA) to identify hemorrhage, vessel occlusion, or vascular malformation structure
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Access & Isolation
Microsurgical craniotomy performed to expose the vessel, or femoral/radial arterial puncture initiated to introduce microcatheters
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Definitive Vascular Intervention
Titanium clips applied across aneurysm necks, malformations embolized/resected, or mechanical thrombectomy performed to restore blood flow
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Post-Operative Neuro-ICU Care
Strict blood pressure control and active monitoring for vasospasm, reperfusion injury, or secondary cerebral edema in specialized neuro-ICU units