Vascular Neurosurgery of the Brain

An aneurysm is a localized, blood-filled balloon-like bulge in the weakened wall of a cerebral blood vessel. Aneurysms can burst and the resulting bleeding (subarachnoid haemorrhage) is a serious, life-threatening condition. The surgery involves treating the bulge in a way so that it cannot burst. In practice, the aneurysm must be found and carefully removed from blood circulation by inserting clips. Surgical treatment is just one possibility. A significant number of aneurysms can also be treated using the endovascular method, which means inserting thin tubes (catheters) into the blood vessels and filling the aneurysm from the inside. This operation is monitored using X-ray on an angiographic line and performed by an interventional neuroradiologist.

An arteriovenous malformation (AVM) is a tangle (nidus) of blood vessels arising at the direct connection between arteries and veins (without a capillary bed). These vessels are highly fragile, and because blood flows through them under relatively high pressure, there is a risk that they will burst, causing bleeding into the cerebral tissue. Epileptic fits and neurological disabilities are symptoms of AVM. Surgery consists of eliminating the pathological communication of arteries and veins and removing the blood vessel tangles and scar tissue. Operations are often performed in cooperation with interventional neuroradiology (filling the tangles with a special glue) and radio-neurosurgery (exposure to Leksell Gamma Knife).

This is a microsurgical procedure which aims to strengthen the blood supply to the brain, typically during the closure of the carotid artery with subsequent ischemic attack. Indication for surgery is conducted on the basis of examination of cerebrovascular reserve capacity (CVRC). The operation itself consists of sewing arteries supplying the soft tissues of the head to cerebral arteries, thereby acquiring another, new “inflow” of blood to cerebral tissue.

The pressure of blood vessels to the cranial nerves can cause problems that may develop with age: typically these are trigeminal neuralgia (a whipping pain in the middle of the face) or facial hemispasmus (uncontrollable twitching of half the face). The operation consists of removing the nerve with the vessel so that the blood vessel is diverted and fixed in its new position with special glue.

As life goes by atherosclerotic plaques and deposits form, gradually closing up the blood vessels. If this situation occurs in the neck (carotid) arteries, the supply of blood to the brain is threatened. Another risk is the possibility of plaque tearing off and getting wedged in the blood vessels of the brain, which is accompanied by a brain attack – a stroke. The operation consists of opening up the blood vessel, removing the plaque and restoring its passability. It is not just performed on patients who have already suffered a brain attack, but mostly as a preventative measure to save the patient from having a stroke. The operation is conducted using a microscope under local anesthesia (cervical block), so the patient is conscious. In some cases it is more appropriate to conduct surgery under general anaesthetic, which is accompanied by continuous monitoring of the patient’s neurological functions (electrophysiological monitoring of evoked potentials) and the flow of cerebral arteries (transcranial Doppler sonography – TCD). Carotid endarterectomy can be performed as an emergency operation in case of sudden closure of the carotid artery. If the passability of the vessel