Neurointerventional surgery encompasses the practice of fluoroscopically guided endovascular procedures for pathologies involving the craniocervical and spinal regions, minimally invasive spinal procedures, and other percutaneous interventions of the head and neck.

Endovascular procedures are catheter-based. Vascular access can be arterial or venous and is classically achieved from the femoral region. Innovations in both devices and techniques have also increased the use of the radial artery as an access site. Diagnostic angiography as well as pharmacological or device-based therapeutics may be performed using a combination of catheters and guidewires of various sizes. Digitally subtracted angiography (DSA) is the gold standard for imaging vascular diseases of the craniocervical and spinal regions. These translate into many pathologies treatable by neurointerventional surgery. They include ischemic stroke, intra- and extracranial atherosclerotic disease, cerebral and cervical aneurysms and pseudoaneurysms, cranial and spinal arteriovenous malformations and fistulae, venous stenosis, and idiopathic intracranial hypertension, to name a few.

Percutaneous spinal procedures primarily target diseases that have resulted in anatomical misalignment or compression of the spinal canal. These procedures can normalize vertebral height, relieve nerve root compression, re-establish spinal alignment, and most importantly, provide minimally invasive solutions to spinal or radicular pain. Under fluoroscopic guidance, rarer diseases such as lymphovascular malformations can also be treated with percutaneous sclerotherapy.

As a rapidly growing field, neurointerventional surgery also continues to expand its therapeutic offering as more and more diseases, both pediatric and adult, become treatable via its minimally invasive approach. It is a young subspecialty at the intersection of neuroradiology, neurosurgery, and neurology. As such, it is also known by several other names: interventional neuroradiology, endovascular neurosurgery, interventional neurology, and endovascular surgical neuroradiology. Neurointerventional surgery is a unique subspecialty in the practice of medicine where each of three parent specialties collaborates and contributes to its constant innovations.

Frequently Asked Questions

1. What is the best way to learn about neurointervention?

  • Attending conferences, webinars, and educational videos
  • Clinical rotations/shadowing
  • Peer-reviewed publications
  • SNIS Mentor Match Program

2. Do I have to do research to be a competitive applicant?

  • Research is an important way to get more in-depth knowledge of the procedures, current practices, and innovations within the field. Being able to present this knowledge at conferences or in publications is a great way to network and drive conversations with like-minded colleagues.
  • Most applicants will seek out a neurointerventional mentor with whom they may collaborate with for research. This may include case reports or series.
  • Having research experience would be helpful, particularly to apply to competitive programs.
  • We encourage trainees interested in the field to hop on board and be engaged with the SNIS through the Young Neurointerventionalists Committee!

3. When in my residency training do I apply?

  • It depends on your training pathway.
  • Please refer to the “Applying to Fellowship” section! The Neurointerventional Fellowship Task Force has prepared a helpful graph to guide the timing in preparation for application, and the upcoming Fellowship Match.

4. What is the future of neurointervention?

Here are some examples of innovations, current as of 2021!

  • Expanding the disease entities that can be treated endovascularly (e.g., transvenous CSF diversion for IIH, MMA embolization for chronic subdural hematoma)
  • Robotics, artificial intelligence, and brain-machine interface
  • Intrasaccular aneurysm embolization devices
  • Growing number of devices designed for radial access

5. Are you on call every day?

  • Most training programs will have 1–2 neurointerventional fellows per year, and jointly with the preliminary year fellow(s), most trainees will be on call every 2–4 days.
  • As an attending neurointerventionalist, call frequency will depend on the number of partners within the practice. Unless a neurointerventionalist is founding the program solo, there are usually at least 2 partners to allow for a 1-in-2 primary call schedule.
  • When considering the number of partners versus call frequency, keep in mind that there is usually need for a back-up call schedule as well, particularly for comprehensive or thrombectomy-capable stroke centers, in the event of an emergency during which the neurointerventionalist on primary call is already in a case.
  • Both during fellowship and in practice, call coverage can include more than one hospital. Therefore, depending on the number and geographical location of the centers covered, there may also be traveling involved to provide coverage.