What is Neurointerventional Radiology?
NeuroInterventional Radiology or NIR is a medical technique to treat conditions that take place in the brain, or the spine and the nerves.
NIR applies minimal and invasive technologies to heal bones, soft tissue nerves and vascular conditions, which affect the central nervous system or the brain, head, neck and spinal cord.
The 5 areas are:
1. Neuro & Spine Procedures
2. Biopsy & ablation/embolization procedures of the endocrine organs and almost all the other organs of the body.
3. Endovascular Procedures.
4. Ob-gyne & IVF procedures.
5. Pain management, general & advanced.
All procedures are minimally invasive, non-surgical and with only local anesthesia or sedation.
Neuro & Spine Procedures
Treating Disc Diseases Using Laser Rays
The most distinguished advantages of laser disc treatment are that it is minimally invasive and can be performed without general anesthesia. Under local anesthesia, avoiding the occurrence of pressure on the disc or the possibility of getting infected with a syndrome after the removal of tissue surrounding the disc herniation through the use of the laser.
Going back to work and sports:
Office work and physical activity can be resumed in one to two weeks. With the need to avoid strenuous physical activity during the first four weeks and then you can increase it gradually.
Swimming and cycling (emphasizing the upright position in each) are also permitted. You can also go jogging on soft surfaces after four weeks. All other sports can be gradually resumed after the fifth week, depending on the severity of the condition.
Success rates of more than 80% have been recorded worldwide and this is supported by my personal experience dealing with and treating more than 15,000 patients.
A bulging or herniated disc is caused mainly by a degenerative condition, but a variety of injuries can lead to these conditions as well. Getting old, the discs of cartilage between the vertebrae, which are usually wet and flexible, begin to dry out. The water loss begins to weaken the outer fibrous layer of the disc, which is called the annulus fibrosus.
The gelatinous substance in the center of the disc is called the nucleus pulposus. The inner material can push out as the outer wall continues to disintegrate, which can cause the wall to bulge, or rupture (herniation), allowing the disc material to slide out of its location. Thus, pain, tingling, weakness and numbness may occur if the disc touches the spinal cord or one of its nerve roots.
When shall we use disc laser treatment:
The hernia or displacement of the lumbar discs is considered a common cause of back pain and sciatic nerve pain, as the hernia occurs as a result of the protrusion of the nucleus pulposus through a rupture in the fibers surrounding the fibrous ring, knowing at that time, laser treatment can be performed if the disc herniation is limited, and this is supposed to save the patient from having open disc surgery. Here is a list of cases that the laser treatment method can be used for:
- Swollen or herniated discs of the vertebrae
- Hard or hard disks
- back surgery failure syndrome
- Disc pain increases during the day
A brief overview of laser treatment:
Disc laser treatment removes the protruding part of the disc by vaporization. The laser procedure can be performed in cases of limited hernias. Laser disc therapy is a minimally invasive procedure that involves removing the inner material of the bulging or herniated part of the disc that touches the nerve root or spinal cord.
Under local anesthesia, a very fine needle is inserted into the disc and the needle is inserted through the ring and then into the herniated part. There are many lasers, each of which differs in terms of absorption, power requirements, as well as rate of application, and this procedure is performed using computer tomography technology to guide the probe in addition to real-time monitoring.
Laser treatment serves the following three main purposes:
- Reducing pressure caused by damaged nerve roots or spinal cord.
- Reconstructing the nucleus pulposus helps remove the remaining disc material from the spinal cord or nerve root and helps to avoid a painful bulge or herniation later on.
- Remove the herniated part of the disc.
Denervation of the pain receptors in the nucleus pulposus is also a part of the treatment, especially since the heating of the disc by the laser leads to the destruction of the sites of production of neurotransmitters (L-glutamate, substance B, peptides, and quinine) and thus disrupts the transmission of pain signals to the brain, which relieves most chronic pain. The laser transforms most of the collagen inside the disc, thus repairing small tears in the disc and stabilizing the fibrous ring.
Steroid Injections into the Epidural Area
What may you feel during the procedure?
Mostly, you won’t feel anything at all; however, you may feel a tingling or pressure feeling when you are injected. Depending on the extent of the swelling in the area, you may feel a slight burning sensation or some discomfort as the medicine enters the epidural area. When the injection is finished, however, any discomfort usually disappears completely. Depending on the injection site, you’ll likely feel tingling in your arms and legs. In some patients, the pain may be severe at first before the situation begins to improve.
Because of the numbness experienced by the patient and the inconvenience that may be experienced after this procedure, the patient may have difficulty walking alone and getting in and out of the vehicle. This is normal and should subside within hours. The patient should rest for the rest of the day. However, it will regain its full normal activity the next day.
What is an epidural injection?
An injection of epidural anesthesia is given into the epidural area of the spine to achieve temporary, prolonged, or even permanent relief from pain or inflammation. The epidural space is located outside the Dural membrane. Steroids, anesthetics, saline and anti-inflammatory drugs are usually injected into the epidural area of the spine. The injection may help treat a herniated disc and reduce edema and pain in and around the spinal nerve roots. This procedure promotes better nerve nutrition by facilitating the diffusion of micronutrients, which leads to the healing of damaged nerves.
What are some common uses for this procedure?
An epidural can be injected to treat the following conditions:
- Herniated disc and cartilage infections.
- The presence of narrowing or hole in the vertebrae of the spine.
- Failed back surgery (chronic back or leg pain after spinal surgery).
- Other injuries to the nerves in the spine and the vertebrae or surrounding tissues.
What should be prepared for this procedure?
You will receive specific instructions on how to prepare for this procedure, including any changes to make to your regular medication schedules.
- You may be asked to wear a surgical gown.
- You will be asked to go to the bathroom before the procedure.
- Then, you will be placed on your back or stomach on a special CT table that will provide the doctor with an easy way to reach the injection site.
A nurse and radiology technician will be on hand to assist the neuroradiologist during the procedure. You should plan for a relative or friend to drive you home after this process has been completed.
How does this procedure work?
Different types of drugs injected into the epidural have different effects. Corticosteroids act as anti-inflammatory drugs, reducing irritation and swelling of the nerves to allow time for the nerve to heal, thus preventing further discomfort by injecting an epidural injection directly into the epidural, the drug moves throughout the epidural space, submerging the roots nerves. Therefore, injections given in the lower back can affect the lower back and the nerves that lead to the lower extremities, such as the sciatic nerves.
We perform minimally invasive treatment of vascular diseases that may be caused by heavy smoking or diabetes. We effectively treat pain in the legs in the majority of our patients using pharmaceuticals and microcatheters, We access the sympathic ganglia, through a needle, which is precisely placed on the site via CT navigation. No surgery or general anesthesia. Patients usually go home after one hour after the procedure.
Other diseases treated:
- Peripheral Vascular Diseases
- Diabetic Angiopathy
- Peripheral Gangrene
- Morbus Raynauld
- Reflex Dystrophy
Back Pain from Head to Pelvis
At our Radiology Department, we perform minimally invasive treatment of back pain at the level of cervical, thoracic and lumbar spine and pelvis. We effectively treat back pain in the majority of our patients using epidural injection, facet block and laser ablation. We access the disk hernia spinal canal, or the facet joint through a needle, which is precisely placed on the site via CT navigation. No surgery or general anesthesia is required. Patients usually go home one hour after the procedure.
Bone Fractures In the Spine and Pelvis
With minimally invasive treatment, we can effectively stabilize fractured bones with the use of CT-navigated cement injection on the affected area through a needle which frequently corrects the deformation of the spine. No surgery or general anesthesia is required. Patients usually go home one hour after the procedure.
As with the majority of our procedures, we also perform minimally invasive treatment of joint disease treating active osteoarthritis rheumatoid arthritis and persisting pain after joint replacement. We can reduce the level of pain for extended periods in the majority of our patients utilising laser or radiopharmaceuticals. We access all the joints through a tiny needle, which is precisely placed via CT navigation. No surgery or general anesthesia. Patients usually go home after an hour after the procedure.
Biopsy & ablation/embolization
Many thyroid disorders can be cured with the latest nonsurgical interventions. An old technique such as manual examination was substituted by the state-of-the-art ultrasound examination. Which can display even the tiniest nodules, and the previous surgical biopsies were substituted biopsies using needles, fine needles viewed through ultrasound.
The extensive use of fine needle biopsies through the visual aid of ultrasound has paved the way to a more successful early diagnosis of thyroid nodules and cancers.
In the last 15 years, medical experts have been trying to replace the old ways of surgical treatments with nonsurgical treatments. Treatments such as ablations and embolizations permit redistribution of both cystic and solid including hot and cold nodules through tiny needles. Embolization made it possible to treat huge goiters without surgery but rather with a simple angiography. This is the latest nonsurgical treatment option and has a massive potential to help patients with thyroid disorders.
An alternative way of treating tumor ablation is an endovascular approach. This is oftentimes used in interventional radiology treatment. The primary goal is to identify the arteries that are feeding the tumors using special angiography machines. Once identified the tumors will be eliminated using tiny catheters.
Fertility &IVF procedures
- Recanalization of Fallopian Tubes
- Percutaneous myomectomy
- Percutaneous ovarian cyst ablation
- Embolization prostate
Uterine Fibroid Ablation
One out of three childbearing-age women is affected by uterine fibroids. Uterine fibroids are benign tumors in the uterine walls. Although benign, it can increase menstruation flows, can be painful, and cause anemia, bloating and frequent urination. If complaints increase and the fibroids are growing it has to be treated.
Surgical treatment options include:
- Hysterectomy (removal of the uterus). However, hysterectomy may cause osteoporosis, depression, increased risks of coronary heart disease and severe (surgical) menopause.
- Myomectomy (removal of fibroids). However, myomectomy may increase the risks of myoma recurrence and may cause an unplanned hysterectomy in the process.
It is because of these surgical risks involved that new alternative treatment methods were developed. The most commonly used and popular in the medical field is the embolization of uterine fibroids or UFE. The arteries supplying the fibroids are clogged with small particles during embolization, which is similar to coronary angiography.
Blocking the arteries that feed the fibroids or myoma die as to preserving the normal uterine tissue. Embolization has the advantage of lowering the risk of the fibroids recurring and saving the uterus. The patient can return earlier than usual to normal life after treatment because embolization is minimally invasive.
General Pain Management
One of the challenges of cancer patients is pain management. An estimated half of cancer patients experience pain that requires treatment anytime during the stage of the disease. Cancer patients at almost two-thirds of the stage of the disease are in excruciating pain. In most cases, it is due to the tumor spreading to the nerves and its compression. Radiotherapy, chemotherapy and other surgical procedures may also be the cause of pain.
The traditional form of pain management for cancer is the administration of pain medications. However, when pain medications become inadequate the dose must be increased and may even administer narcotic drugs. When the narcotic drugs are no longer enough some other pain relief measures must be done. The most recommended pain relief is the intervention of nerve blocks.
Most particularly the celiac ganglion block used for pains in the abdomen is a huge success in relieving pain brought about by the tumors in the pancreas and stomach cancer or the upper abdominal region. It is the same way it is beneficial for hypogastric ganglion where the pain from the tumor is experienced in the lower abdomen.
One of the main sources of pain in cancer is the spreading of tumors in the bone and the diminishing of the periosteum, which is the outer membrane of the bone. The traditional approach to bone tumors is radiotherapy. But there is a disadvantage with radiotherapy the effect begins later maybe a few weeks. Thus, patients may be relieved later on making half of the patients of 20-30% experience recurring pain for months. As well as, radiotherapy cannot be implemented in the same area.
Percutaneous ablation of the periosteum is very beneficial to some patients. However, pain management is widely effective and is longer lasting than radiotherapy.
There are some cancer patients whose bones become fragile and disintegrate this is called compression fractures. The vertebrae are the common target and will not be able to carry the weight of the body. Some patients will need to be injected with special cement into the vertebrae with a needle in the early stage of bone disintegration. This procedure is called vertebroplasty or kyphoplasty.