Delaney Radiologists

Neurointerventional Therapy

  • Catheter (non-surgical) treatment of brain aneurysms and vascular malformations (AVM)
  • Stroke therapy
  • Traumatic craniofacial bleeding and nosebleeds
  • Tumor embolization

Interventional Neuroradiologists

Interventional neuroradiologists are subspecialized doctors who are involved with the evaluation and treatment of selected patients with certain disorders of the brain, spine, and facial region. Only about a dozen of these specialists are practicing in North Carolina. Delaney Radiologists Group is proud to have two of them in Wilmington: Fred Scialabba, M.D. and Joe Wehner, M.D.

Interventional neuroradiology (INR) procedures often are able to treat or assist in the treatment of disorders utilizing minimally invasive techniques requiring only local anesthesia. Usually the procedures are done by way of a catheter placed through a small skin puncture in the groin. Some patients may receive mild sedation, but the procedures are generally not painful or unpleasant. Some patients are able to go home the same day.

Some patients have come to describe this as "brain surgery from the inside." INR procedures may reduce some of the risks associated with traditional open neurosurgical procedures. In some circumstances, both INR and neurosurgical techniques may be necessary to treat a complex problem. In all situations, our doctors work closely with our colleagues in neurosurgery, neurology, ENT, and intensive care medicine to develop a comprehensive management plan for each individual patient and particular problem.

Neurointerventional Treatments

Brain Aneurysm Therapy

Brain aneurysms can be a source of headaches, neurologic changes, stroke, or death, and represent one of the major neurologic causes of death and disability in the United States. Depending on many factors, aneurysms may be treated by close observation, open neurosurgery, or endovascular coil embolization (ECE). ECE has received recent publicity from news reports of the publishing of a large recent medical study from Europe supporting ECE for treatment of ruptured aneurysms, showing an outcome better than surgery for selected aneurysms. Certainly, more study is needed prior to drawing more broad conclusions, but this large study has accelerated the growth of this form of therapy. In ECE, a small incision is made under local anesthesia in the groin (about 1/4 inch) to enter the femoral artery and a catheter is directed into the brain blood vessels. Using a very small catheter to enter the aneurysm, it is filled with specialized platinum coils like a tiny ball of yarn which promotes the sealing off of the aneurysm. ECE is only performed at a handful of centers in North Carolina. We are one of the pioneering centers in the state for this therapy, having performed this procedure since its approval by the FDA in 1996.

For more information on coil therapy of aneurysms, visit the American Society of Interventional and Therapeutic Neuroradiology (ASITN) website.

Brain Tumor and Vascular Malformation Embolization

For certain kinds of brain tumors, particularly a common tumor called a meningioma, INR techniques are used to diminish the risk of bleeding during neurosurgical removal of these tumors. Through a small incision in the groin, a very small catheter is used to enter the blood vessels supplying the tumor. Special materials are used to close off the tumor blood supply, preserving the normal brain blood vessels. This can make the subsequent open surgical removal safer and faster, by making the tumor less rich in blood vessels and easier to separate from adjacent vital structures. By similar techniques, INR methods can control or close off certain types of brain vascular malformations, such as arteriovenous malformations or AVMs. These are often mass-like tangles of blood vessels that may cause bleeding, stroke, headaches or seizures. We work closely with our neurosurgical colleagues to appropriately select patients who would benefit from these techniques.

Embolization of Craniofacial Bleeding, Including Severe Nosebleeds

In some situations in which bleeding of the face, inner nose, neck or other similar bleeding conditions is a problem, INR techniques can control the bleeding and prevent the need for emergency open surgery. A small incision or puncture is made in the groin (about 1/4 inch) to enter the artery, a catheter is directed into the bleeding blood vessels, and special materials are used to control the bleeding. This procedure may be life-saving and may eliminate the need for other surgery.

There are many other neurointerventional applications which are beyond the scope of this brief summary. For more information, please refer to the American Society of Interventional and Therapeutic Neuroradiology website.

[ to top ]