Vascular neurosurgery

We specialise in the following neurovascular diseases:

• Aneurysms (vascular protrusions) of the cerebral arteries, including so-called "giant aneurysms" with > 2.5 cm
• Arteriovenous malformations (AVMs): Angiomas (haemangiomas), fistulae of the cerebral vessels (abnormal short-circuit connection between vein and artery)
• Cavernomas (benign vascular malformations of the central nervous system in the brain and spinal cord)
• Spinal vascular malformations (AV fistulas affecting the spinal cord, spinal AVMs, intramedullary cavernomas)
• Neurovascular compression syndromes (especially trigeminal neuralgia: Lightning-like pain in the facial nerve; facial hemispasm: Unilateral involuntary spasm of the facial muscles)

Depending on the disease, we use the following techniques:

• Aneurysms: Transcranial, open microsurgical clipping (closure of the aneurysm with a special clip) or wrapping (reinforcement of the aneurysm wall by wrapping with muscle or special cotton wool)
• AVMs, fistulas, cavernomas: Transcranial, open microsurgical ligation of the vascular shunt, removal of the vascular node if necessary
• Neurovascular compression syndromes: Minimally invasive microsurgical neurovascular decompression and insertion of an interposition (placeholder) to permanently prevent renewed vascular-nerve contact

The following additional techniques are routinely used in all procedures:

• Fluorescent dyes (indocyanine green, sodium fluoresceine) and micro-Doppler ultrasound to visualise the blood flow within the vessels, the aneurysm or the angioma (AVMs)
• Intraoperative control of aneurysm clipping by ICG angiography (indocyanine green angiography)
• Continuous neuromonitoring (to check the motor and sensory pathways from the brain to the extremities)

Aneurysms

Some aneurysms (widening of blood vessels) can be treated "from the inside" (endovascularly) during an angiography. Neuroradiologists insert special stents such as "flow diverters", platinum coils or WEBs (Woven EndoBridge Devices) into the pathologically dilated vessel.

Other aneurysms are better suited to open microsurgery (clipping). In this procedure, a clip is placed on the aneurysm "from the outside" to seal it for life.

Together with our neuroradiology colleagues, we determine the most appropriate interdisciplinary treatment strategy for each patient. During the interdisciplinary neurovascular consultation, we discuss the recommendation and decide on the individual procedure together with the patient.

For both types of treatment, patients are admitted to one of the neurosurgical wards. The hospital stay is 4-7 days. After the operation, a diagnostic angiogram is usually performed during the inpatient stay. If this confirms complete occlusion of the aneurysm, no further follow-up is necessary.

Arteriovenous malformations (AVMs)

Arteriovenous malformations (AVMs) such as AV fistulas and angiomas of the brain or spinal cord are diagnosed and treated in the same way.

These vascular anomalies have different characteristics in each patient and require specific diagnosis for each patient using magnetic resonance imaging (MRI) and angiography. Not every AVM needs to be treated. The risk of bleeding for each individual patient can be determined with further diagnostic tests.

In our interdisciplinary neurovascular consultation, we will advise you personally and work with you to plan the best possible treatment for your individual needs.