Vascular Neurosurgery

What Is Vascular Neurosurgery?

Vascular neurosurgery is a subspecialty of neurosurgery. Neurosurgery refers to procedures of your brain, spine, spinal cord, and nerves (central nervous system). Vascular neurosurgeons specialize in conditions affecting the blood vessels that carry blood to and from your brain and spinal cord.

Vascular neurosurgery includes both open and endovascular (uses no surgical cuts) approaches. Our vascular neurosurgeons are experts in both these techniques.

Why Choose University of Utah �ǿմ�ý?

Our vascular neurosurgery team includes global experts in open and endovascular surgery and research. We work closely with each other, so you get the combined expertise of multiple doctors. We also coordinate with vascular neurologists, neuroradiologists, and other specialists to bring you comprehensive care. This means we personalize each treatment plan to your needs. Providers across the region refer their patients to us because we have the skills to treat even the most complex conditions.

As the premier academic institution in the Mountain West region, we study new treatments and bring you the latest techniques, including through clinical trials. U of U �ǿմ�ý neurosurgeons lead an to train the next generation of surgeons.

REGION'S LEADER
in vascular neurosurgery clinical trials

UTAH'S ONLY
endovascular neurosurgery fellowship

REGION'S FIRST
Comprehensive Stroke Center

Types of Neurovascular Surgery

Vascular neurosurgeons specialize in conditions affecting the blood vessels that carry blood to and from your brain and spinal cord. They can also treat problems that aren’t typically categorized as blood vessel problems. Vascular neurosurgeons can treat various problems by working through the blood vessels.

Our team uses both open and minimally invasive surgery techniques. Open surgeries may use microsurgical techniques, where we operate under a microscope, as well as minimally invasive techniques. For endovascular approaches, we insert a thin, flexible tube (catheter) through one of your blood vessels without needing to make a large incision (cut).

We choose the procedure best suited to your health needs. Your individualized treatment plan depends on your diagnosis, age, and overall health.

Endovascular Procedures

Arteriovenous malformation (AVM)/fistula embolization—Your neurovascular surgeon uses a catheter to deliver a specialized substance (embolic agent) to the fistula or malformation. This closes off the atypical connection between your artery and vein.
Balloon angioplasty/stenting—Your neurovascular surgeon uses an angioplasty to open narrowed or blocked blood vessels. They will insert a thin, flexible tube (catheter) with a balloon through one of your blood vessels. They will inflate the balloon in the blocked area to allow blood to flow normally through your blood vessels. They place a stent (small, flexible mesh tube) to prevent the blockage from returning.
��Ǿ��Բ�—Your neurovascular surgeon uses coiling to treat aneurysms. They will insert a catheter with a small, flexible wire (coil) through your blood vessel. The coil seals the aneurysm to stop it from bleeding.
Flow diversion or intrasaccular flow disrupter placement—Your neurovascular surgeon uses stents and intrasaccular devices to treat brain aneurysms. They will place a small, flexible mesh tube (stent) in your blood vessel or a highly flexible device (intrasaccular device) within the aneurysm. This directs blood away from an aneurysm, making it less likely to burst.
Middle meningeal artery embolization—Your neurovascular surgeon uses this approach to treat a subdural hematoma. They guide a catheter to the artery supplying blood to the subdural hematoma. Then they release specialized pellets to stop bleeding.
�ճ��ǳ��𳦳ٴǳ��—During this procedure, your neurovascular surgeon removes a blood clot from one of your blood vessels. They use multiple techniques to remove clots and restore blood flow.

Open Procedures

Carotid endarterectomy—Your neurovascular surgeon will make a small incision (cut) over the carotid artery in your neck. Then, they will remove plaque from your artery to restore blood flow.
Intracerebral hemorrhage evacuation—Your neurovascular surgeon will remove a hemorrhage from within your brain. Surgeons often use a minimally invasive open technique where they use a tube to suction out the excess blood.
Microsurgical AVM resection—Your neurovascular surgeon operates under a microscope to remove an AVM from within your brain tissue.
Microsurgical bypass—Your vascular neurosurgeon sews a vascular graft in place. This restores blood flow to portions of your brain.
Microsurgical cavernoma resection—Your vascular neurosurgeon operates under a microscope to remove a cavernoma from within your brain tissue.
Microsurgical clipping—Your vascular neurosurgeon uses clipping techniques to treat aneurysms. They will place a metal clip across the aneurysm to stop it from bleeding.

Innovations in Vascular Neurosurgery

We can treat several conditions with the latest vascular neurosurgery techniques:

Idiopathic intracranial hypertension—This condition occurs when pressure increases around your brain. Treatment used to include open surgery to place a shunt (tube) in the brain. Now, vascular neurosurgeons can use minimally invasive techniques to place stents (flexible, mesh tubes) in the brain.
Headaches—Many people experience chronic headaches with underlying neurological causes. Vascular neurosurgeons can block (embolize) the middle meningeal artery, one of the blood vessels supplying blood to the brain, to treat headaches.
Cerebrospinal fluid (CSF)-venous fistulas—CSF-venous fistulas are irregular connections between blood vessels around your spinal cord. They can lead to intracranial hypotension (low pressure in the brain). Vascular neurosurgeons block (embolize) these blood vessels to prevent intracranial hypotension.

Find a Neurovascular Surgeon

What to Expect During Your First Visit With a Vascular Neurosurgeon

Many of our patients have already seen a neurologist before their visit. You may have already had imaging and gotten a diagnosis if you’ve seen a neurologist. Your neurovascular surgeon will discuss your imaging and diagnosis with you at your first visit.

We will often order tests to help us get a closer look at your blood vessels:

��Բ��ǲ��—Your neurovascular surgeon will insert a catheter (thin, flexible tube) with contrast dye through your blood vessels. This contrast dye lets us look more clearly at your brain’s blood vessels on an imaging scan.
CT scan—These tests use a series of X-rays and special computers to look inside your body.
MRI—These tests use magnets and radio waves to create a clear picture of the inside of your body.

Your neurovascular surgeon will discuss your test results and potential treatments with you. Sometimes, you don’t need any treatment besides monitoring the problem to see if it worsens. Other times, you may benefit from open or endovascular surgery. Your surgeon will help you understand your condition and recommend effective management techniques.

Managing Vascular Diseases of the Brain & Spinal Cord

Experts divide vascular diseases of the brain and spinal cord (central nervous system) into two types: ischemic and hemorrhagic conditions.

Ischemic diseases occur when there’s not enough blood reaching an area of your body:

Carotid artery disease—This is when the blood vessels in your neck narrow due to plaque (fatty substance) buildup.
Intracranial atherosclerotic disease—This occurs when your brain’s blood vessels narrow due to plaque buildup.
Moyamoya disease and syndrome—This occurs when your brain’s blood vessels narrow due to a problem with the blood vessels themselves.

Hemorrhagic diseases occur when you have unwanted bleeding:

��Ա�ܰ��—This is a bulge in your blood vessel wall that could burst. This causes a life-threatening bleed called a subarachnoid hemorrhage.
Brain arteriovenous malformation—These are tangles of the blood vessels that connect the arteries and veins in your brain. It’s not normal for these blood vessels to be tangled. These tangled blood vessels can weaken and burst, causing bleeding in your brain.
�䲹��Դǳ��—This is a tangle of tightly packed small blood vessels (capillaries) that shouldn’t be there. Symptoms may include headaches, seizures, or neurologic problems. The tangle can burst and cause bleeding.
Chronic subdural hematoma—This condition occurs when blood pools on the surface of your brain. It usually occurs after a head injury and can be life-threatening without treatment.
Dural/pial arteriovenous fistula—These are atypical connections between arteries and veins in the brain. Arteriovenous fistulas can be genetic, they can develop later in life, or they may be the result of a traumatic injury. Arteriovenous fistulas can lead to neurologic problems, headaches, ear ringing or whooshing (pulsatile tinnitus), and bleeding.
Spinal vascular malformations—These are connections between arteries and veins in or near your spinal cord that aren’t normal. They can include arteriovenous fistulas and spinal arteriovenous malformations. These can lead to neurologic symptoms or bleeding.

A stroke can be ischemic or hemorrhagic. A stroke is an interruption of blood flow in your brain that requires emergency treatment.

Symptoms of Vascular Disease in the Brain

Many people don’t have any symptoms of a neurovascular disease. Sometimes the first signs of a neurovascular disease are symptoms that require emergency care. These symptoms come on suddenly:

Difficulty seeing
Dizziness or balance problems
Face drooping
Severe headaches
Weakness or numbness, especially on one side of your body

These symptoms point to an emergency condition:

Stroke: A stroke requires immediate, emergency care to avoid damage to your brain tissue.
Transient ischemic attack (TIA): A TIA occurs when you experience stroke symptoms for a short period, then symptoms disappear. You should seek treatment for a TIA. It can be a warning sign of a future stroke.

Other people may find out they have a neurovascular disorder when they have imaging tests for another problem.

Schedule an Appointment for Neurovascular Surgery

You don’t need a referral to schedule an appointment with our neurovascular surgeons. Call 801-585-6065 or request an appointment online. Our patient care coordinator will help verify your insurance coverage and schedule your visit.

Picture of TBI patient Jenny Rhoads Larkin

Hear from Our Patients

In August 2019, Jenny Rhoads Larkin was hit by a car during one of her daily runs. She suffered many injuries, including a severe traumatic brain injury. She suffered physically from the trauma for many weeks until she arrived at U of U �ǿմ�ý where a team of neurologists and neurosurgeons discovered a large aneurysm in the carotid artery of her skull.

Read Jenny's Story