Northeast Florida Medicine
Vol. 66, No. 3 2015
11
Guest Editorial
A Look at Endovascular Neurosurgery
We are very honored by the opportunity to help create
this issue of
Northeast Florida Medicine
about endovascular
neurosurgery. The concept of endovascular treatment of
cerebrovascular disease became a modern reality with the
description of aneurysm coiling in 1991. Since that time,
the field has grown dramatically.
Similar to the shift that has occurred in cardiology over
recent decades, catheter-based treatment for cerebrovascu-
lar disease is now displacing craniotomy and open surgical
techniques at a rapid pace.
The endovascular approach with less invasive technol-
ogy minimizes the associated morbidity with vascular
procedures. As an example, the advent of flow diverters
is changing the paradigm of aneurysm treatment and al-
lowing safe management of extraordinary lesions which,
until recently, would have necessitated lengthy surgery
with a high risk profile.
Catheters can now be navigated safely within all the
vascular territories of the brain. This allows embolization
of arteriovenous malformations and tumors with liquid
embolic material, which can facilitate resection while
minimizing blood loss.
While carotid endarterectomy remains an excellent
surgery, carotid angioplasty and stenting has emerged as
a valuable alternative for a high risk candidate.
While the advances in technology now allow for safer
treatment of certain cerebrovascular diseases, it expands
and revolutionizes the treatment of other conditions.
Nowhere is this more evident than in the treatment of
acute ischemic stroke from large vessel occlusion. The
randomized trials published in the
New England Journal
of Medicine
over the last year have confirmed clot retrieval
and mechanical thrombectomy to be the standard of care
for this disabling condition.
In this issue of
Northeast Florida Medicine
, we have
included authors from all current Northeast Florida in-
stitutions where subspecialized neurointerventionalists
are present.
Dr. David Miller
from Mayo Clinic Florida highlights
the history of our relatively young field and discusses the
principal landmarks of our technology driven specialty.
Our group from
Lyerly Neurosurgery
, an affiliate of
Baptist Health, reviews endovascular brain aneurysm
treatment and provides an overview of all the current
modalities available.
Dr. Benjamin Brown
from Mayo Clinic Florida demy-
stifies spinal dural arteriovenous fistulas, a potentially
disabling spinal vascular pathology that is frequently
missed or misdiagnosed.
Our team also provides an update on carotid disease
therapy and the role of angioplasty and stenting in se-
lected patients.
Dr. Philipp Aldana
from University of Florida, Jack-
sonville, along with our team, discusses the exciting and
newly confirmed role of endovascular therapy for acute
ischemic stroke secondary to large vessel occlusions.
Finally, we review the role of endovascular therapy
and the various modern options available in the complex
management of brain arteriovenous malformations.
We are fortunate to practice cerebrovascular neurosur-
gery in this exciting time. We hope this issue reflects our
enthusiasm and that you find this update helpful when
discussing this complicated conditionwith your patients.
v
Ricardo Hanel, MD
Guest Editor
Eric Sauvageau, MD
Guest Editor
