Arteriovenous Fistulas
Overview:
An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein in the brain or spinal cord. Normally, blood flows from arteries into tiny vessels called capillaries, then into veins. With a fistula, blood skips the capillaries and flows directly into a vein, which can cause high pressure and bleeding. AVFs may be present at birth or develop later due to injury, surgery, or unknown causes.
Common Symptoms:
- Headaches that do not go away
- Pulsing noise in the ear (called a bruit)
- Seizures
- Weakness or numbness in the face, arms, or legs
- Vision problems
- Sudden bleeding in the brain (hemorrhage), which may cause stroke-like symptoms
Treatments & Procedures:
- Endovascular embolization – a minimally invasive procedure where a catheter is guided through blood vessels to the fistula, and special materials are used to block abnormal blood flow
- Microsurgical repair – surgery to remove or close the fistula directly
- Stereotactic radiosurgery – focused radiation used to close small or hard-to-reach fistulas over time
- Monitoring with imaging – for small AVFs that are not causing symptoms, regular scans may be recommended before deciding on treatment
Arteriovenous Malformation
Arteriovenous Malformation
Overview:
An arteriovenous malformation (AVM) is a tangle of abnormal blood vessels in the brain or spine. These vessels can break and bleed or cause pressure on nearby tissue. AVMs are usually present at birth but may not be found until symptoms appear.
Common Symptoms:
- Seizures or headaches
- Sudden neurological changes, such as weakness or numbness
Treatments & Procedures:
- AVM resection: Surgical removal of the AVM to prevent future bleeding
- Intraoperative angiography: Used to guide surgery and confirm full removal
- Some AVMs may also be treated with radiation or endovascular techniques
Carotid Artery Disease
Overview:
Carotid artery disease happens when the main blood vessels in your neck, called carotid arteries, become narrow or blocked. These arteries carry blood to your brain. When they are blocked, your risk of stroke goes up. Treatments like carotid surgery or stenting can open the arteries, restore blood flow, and lower stroke risk.
Symptoms:
- Sudden weakness or numbness in the face, arm, or leg (often on one side)
- Trouble speaking or understanding words
- Vision changes in one or both eyes
- Mini-strokes
Treatments & Procedures:
Surgical Treatments
- Carotid Endarterectomy – Surgery to remove plaque from inside the carotid artery to improve blood flow to the brain.
- Carotid Artery Surgery – A general term for surgeries to repair or clear a blocked carotid artery.
- Cerebral revascularization: May be used to improve blood flow in certain cases
Minimally Invasive Treatment
- Carotid Stenting – A small mesh tube (stent) is placed in the artery using a catheter to hold it open without open surgery.
- Vascular Stenting – A similar approach used for narrowed arteries, including the carotid artery.
Non-Surgical Treatments
- Medical and Lifestyle Care – Using medicines and healthy habits to slow the disease and prevent stroke. This may include blood thinners, cholesterol-lowering drugs, controlling high blood pressure and diabetes, regular checkups, eating a heart-healthy diet, staying active, and quitting smoking.
Cavernous Malformations
Overview:
Cavernous malformations are clusters of abnormal blood vessels in the brain or spinal cord. These vessels are thin and weak, which makes them more likely to leak small amounts of blood over time. Some people are born with a cavernous malformation, while others develop them later in life. Many cavernous malformations never cause symptoms, but some can lead to headaches, seizures, or neurological problems depending on where they are located.
Common Symptoms:
- Headaches
- Seizures
- Weakness in the arms or legs
- Numbness or tingling
- Vision changes
- Problems with balance
- Difficulty speaking
- Sudden neurological changes after a small bleed
Treatments & Procedures:
- Surgical removal: May be recommended if the malformation is causing symptoms or bleeding
- Imaging and monitoring: Regular brain scans may be used for small or symptom-free malformations
Cerebral Aneurysm
Overview:
A cerebral aneurysm is a weak spot in a blood vessel in the brain that can bulge or balloon out. If it leaks or bursts, it can cause bleeding in the brain, which may be life-threatening. Aneurysms may be caused by genetics, high blood pressure, or injury. Some people never have symptoms, while others may have warning signs before a rupture.
Common Symptoms:
- Sudden, severe headache
- Nausea, vision changes, or loss of consciousness
Treatments & Procedures:
- Aneurysm clipping: A small metal clip is placed around the base of the aneurysm to stop blood flow to it
- Intraoperative angiography: Imaging used during surgery to guide treatment and confirm blood flow
- Additional treatments may include endovascular coiling (by interventional specialists)
Moyamoya Disease
Overview:
Moyamoya disease is a rare condition where arteries at the base of the brain become narrowed over time. The body tries to grow new blood vessels, but they are often weak and may bleed. This disease can lead to strokes or seizures and is more common in children and young adults.
Common Symptoms:
- Stroke or transient ischemic attacks (TIAs)
- Headaches or seizures
Treatments & Procedures:
- Cerebral revascularization: A surgery that improves blood flow to the brain by connecting healthy blood vessels
- Imaging and follow-up: Ongoing scans to monitor blood flow and vessel changes
Stroke
Overview:
A stroke happens when blood flow to part of the brain is blocked or when a blood vessel bursts. This can cause brain damage that affects speech, movement, or memory. Quick treatment is critical. Strokes can be caused by clots, bleeding, or narrowed arteries.
Common Symptoms:
- Sudden weakness or numbness on one side of the body
- Slurred speech or difficulty understanding speech
- Sudden vision loss in one or both eyes
- Sudden severe headache with no known cause
- Sudden loss of balance or coordination
Treatments / Procedures:
- Emergency Stroke Care
- Clot-busting medicines (thrombolytics) for eligible patients
- Endovascular procedures to remove a clot (mechanical thrombectomy)
- Care from other specialists when needed
- Surgical & Advanced Procedures
- Cerebral revascularization to restore blood flow in select cases
- Intraoperative angiography to guide complex stroke surgery
- Tests & Monitoring
- Brain imaging, such as CT or MRI, to identify stroke type
- Carotid artery imaging and monitoring
- Electroencephalography (EEG) when needed
- Recovery & Rehabilitation
- Physical therapy to improve movement
- Occupational therapy to support daily activities
- Speech therapy for communication and swallowing
- Stroke Prevention
- Medications to reduce future stroke risk
- Personalized prevention strategies
We've highlighted some of the most common services—please explore the conditions list for treatments by condition.
Aneurysm Clipping and Embolization
Aneurysm Clipping and Embolization
Overview:
Brain aneurysms are weak spots in a blood vessel that can balloon and sometimes burst. Clipping and embolization are two ways to treat them. Clipping is surgery to place a small metal clip on the base of the aneurysm. Embolization uses a catheter to place tiny coils or devices inside the aneurysm to block blood flow.
Conditions Treated:
- Brain aneurysms (ruptured or unruptured)
Before the Procedure:
You will have brain imaging tests such as CT, MRI, or angiography to locate the aneurysm. The care team will review your medicines and may ask you to stop blood thinners. You will meet with anesthesia and the surgical team to go over the procedure.
After the Procedure:
You may spend time in the ICU for close monitoring. Pain medicine and blood pressure control help with recovery. Most patients stay in the hospital for several days. Your doctor will schedule follow-up imaging to make sure the aneurysm is fully treated.
AVF Embolization
Overview:
An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. Embolization is a minimally invasive treatment where a catheter is guided into the fistula and blocked with coils, glue, or other materials.
Before the Procedure:
You will have an angiogram to find the exact location of the AVF. You may be asked to avoid food and drink for several hours before. An anesthesia team will explain how you’ll be kept comfortable.
After the Procedure:
You will be observed in the hospital to make sure the AVF is fully closed. Some patients go home the next day. Follow-up imaging will be scheduled to confirm success.
AVM Resection, Embolization, and Radiosurgery
AVM Resection, Embolization, and Radiosurgery
Overview:
An arteriovenous malformation (AVM) is a tangle of abnormal blood vessels in the brain or spinal cord. Treatments include resection (surgical removal), embolization (blocking the blood vessels with glue-like material), and radiosurgery (using focused radiation to close the AVM).
Before the Procedure:
You will need brain imaging and an angiogram to map the AVM. Your neurosurgeon will explain which treatment is safest for you. Some patients may need a combination of treatments.
After the Procedure:
You may need a short hospital stay for monitoring. After radiosurgery, the AVM closes slowly over months to years, so regular imaging will be needed. Your care team will follow you closely to check for any new symptoms.
Carotid Endarterectomy and Stenting
Carotid Endarterectomy and Stenting
Overview:
Carotid arteries supply blood to the brain. If they become narrowed, there is a risk of stroke. Carotid endarterectomy is open surgery to remove plaque from the artery. Carotid stenting is a minimally invasive option where a stent (tiny mesh tube) is placed to keep the artery open.
Conditions Treated:
- Carotid artery disease
- Stroke prevention in patients with carotid narrowing
Before the Procedure:
You will have an ultrasound or angiogram of your carotid arteries. The care team will review your health and adjust medications as needed.
After the Procedure:
You may stay in the hospital overnight. Blood pressure will be closely monitored. Most patients return to light activity in a few days, with full recovery in a few weeks.
Cerebral Revascularization
Cerebral Revascularization
Overview:
Cerebral revascularization is surgery to improve blood flow to the brain. It may involve bypass surgery, where a healthy artery is connected to a brain vessel to reroute blood.
Conditions Treated:
- Moyamoya disease
- Complex aneurysms
- Severe narrowing of brain arteries
Before the Procedure:
Imaging tests will show how blood is flowing in your brain. Your surgeon will explain which artery will be used for the bypass. You may need to stop certain medicines before surgery.
After the Procedure:
You will stay in the ICU for monitoring of brain blood flow. Recovery includes hospital observation and follow-up scans. Most patients need several weeks of rest before returning to normal activity.
Intracranial Stenting for Atherosclerotic Disease
Intracranial Stenting for Atherosclerotic Disease
Overview:
Atherosclerosis is the buildup of plaque inside arteries, which can narrow brain vessels. Intracranial stenting uses a tiny mesh tube to hold the artery open and restore blood flow.
Conditions Treated:
- Severe intracranial atherosclerosis
Before the Procedure:
You will have imaging tests to measure artery narrowing. You may start or adjust blood-thinning medicines before the procedure.
After the Procedure:
You may go home within a day or two. Long-term blood thinners are often prescribed. Follow-up scans help confirm the artery stays open.
Mechanical Thrombectomy
Overview:
Mechanical thrombectomy is a minimally invasive treatment for certain strokes. A catheter is used to reach the blocked artery in the brain and remove the blood clot.
Conditions Treated:
- Acute ischemic stroke caused by large blood clots
Before the Procedure:
This is an emergency procedure. You will have a CT or MRI scan to confirm a clot. The team acts quickly to restore blood flow.
After the Procedure:
Patients go to the ICU for close observation. Recovery depends on how quickly the clot was removed and the amount of brain affected. Rehab may be needed.
Resection of Eloquent and Brainstem Cavernous Malformations
Resection of Eloquent and Brainstem Cavernous Malformations
Overview:
Cavernous malformations are clusters of abnormal blood vessels that can bleed or cause seizures. When they occur in eloquent (important functional) areas or in the brainstem, surgery requires special precision to safely remove them.
Conditions Treated:
- Symptomatic cavernous malformations in sensitive brain areas
Before the Procedure:
You will undergo MRI scans and possibly functional brain mapping. The surgeon will review risks, since these areas control movement, speech, or other key functions.
After the Procedure:
You may stay in the ICU at first, then move to a regular room. Rehabilitation such as physical, speech, or occupational therapy may be needed. Recovery depends on the location of the malformation.
Tumor Embolization
Overview:
Tumor embolization is a minimally invasive procedure that blocks the blood supply to a brain or spinal tumor. This helps shrink the tumor or reduce bleeding before surgery.
Conditions Treated:
- Brain and spinal tumors with large blood supply
Before the Procedure:
You will have an angiogram to map the tumor’s blood vessels. Your care team will explain whether embolization will be followed by surgery.
After the Procedure:
You may stay overnight in the hospital. Headache or fatigue is common for a few days. If surgery is planned, it usually follows soon after embolization.
Venous Stenting
Overview:
Venous stenting is used when large veins in the brain or neck are narrowed or blocked, leading to headaches, swelling, or increased brain pressure. A stent is placed to keep the vein open and restore blood flow.
Conditions Treated:
- Venous sinus stenosis
- Idiopathic intracranial hypertension (IIH)
Before the Procedure:
You will have venography (imaging of the veins) to confirm narrowing. Blood-thinning medicine may be started before the procedure.
After the Procedure:
You may stay in the hospital overnight. Most patients return to normal activity within a week. Blood-thinning medicine is continued, and follow-up imaging checks the stent.
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