Neurovascular

The team provide comprehensive diagnosis and treatment of cerebral (brain) and spinal vascular pathologies.

Our service treats:

subarrachnoid haemorrhage; due to a leakage of blood from a blood vessel beneath the arachnoid membrane that covers the brain.
brain aneurysms; formed when there is a weakness in the blood vessel (artery) causing a ballooning or ‘out-pouching’ that fills with blood.
brain and spinal arterio-venous malformations (AVMs); an abnormality of the blood vessel network.
cavernoma and cavernous malformations; a cluster of abnormal blood vessels

These patients are managed by neurosurgeons and interventional neuroradiologists.

A nurse specialist provides clinical and psychosocial support and advice, during their hospital stay and during onward recovery.

About us

The service consists of Neurosurgeons, Neuro-Interventional radiology consultants, specialist radiographers, Nurse specialists and a co-ordinator.

We have excellent links with our Neuro-rehabilitation Unit (Sussex Rehab Centre), Neuropsychology and Neurology Consultants.

What happens at your appointment

You may have an appointment with either a consultant In Neurosurgery/ neuroradiology or in a joint clinic with both.

You will also have an appointment with the Specialist nurse this will be either over the phone or face to face.

Patient management and care is a multidisciplinary approach with a weekly multidisciplinary team (MDT) meeting.

Imaging

You may require scans to diagnose and treat your neurovascular problem. Some scans require an injection of special dye to show up the blood vessels, known as an angiogram. The team will discuss this with you and what preparations are needed for you to have these investigations safely.

For more information on imaging, please visit our service page.

Treatment

If an aneurysm is found to have caused the bleed then it may be treated by;-

endovascular coil embolisation (“Coiling”)
craniotomy and clipping of the aneurysm (“clipping”)
conservative management

The choice of treatment will be made by your consultant neurosurgeon along with the consultant interventional radiologist and multidisciplinary team.

Endovascular coil embolisation (“Coiling”)

This is performed under a general anaesthetic and involves the passage of a soft catheter through a blood vessel in the groin or wrist up into the blood vessels within the brain. Multiple platinum coils are then deployed within the aneurysm causing the aneurysm to block-off from the normal circulation. In some cases there may be a need for additional stenting procedures which would then necessitate a course of blood thinning medications such as aspirin and clopidogrel for around three to six months. This procedure is less invasive than surgery and carries a quicker recovery period and normally a hospital stay of one to two days at most.

There is also a small chance with this modality that the aneurysm may recur and therefore patients are routinely offered surveillance MRI scans at 6 months and 2 years post treatment (and possibly longer) with a small possibility that retreatment may be required.

Craniotomy and clipping of the aneurysm (“Clipping”)

This is open brain surgery under general anaesthetic which involves an incision in the side of the scalp, removal of a window of bone to access the brain and then the application of one or more clips to occlude the aneurysm from the normal circulation and hence prevent it from rupturing in the future. This normally involves a hospital stay of around five to seven days and then a recovery period at home lasting a few months. Surgery has the benefit of being more durable than endovascular coil embolisation and it generally does not require any further treatment or long term follow-up.

Conservative management

Repeating scans and remaining under surveillance to monitor and be reviewed by the team when appropriate.

The choice of treatment will be made with you by the Consultant Neurosurgeon along with the Consultant Interventional Radiologist and multidisciplinary team.

There is a lot of information to take on board and we advised that you take some time to think through options and discuss with her family and friends as well as the Neurovascular Nurse specialists.

After treatment

After your aneurysm is treated, you will often spend some time in a high dependency unit. Depending on how you are and what treatment plan has been ordered by your consultant.

You will be seen by the consultant and specialist neurovascular nurses and once you are ready you will either go home or to another hospital for local rehabilitation. You will go home when the team, including physiotherapists, occupational therapists and speech therapists feel it’s safe for you to do so.

Follow-up

Your follow-up will be with your neurovascular nurses and consultant. You will return around two to three months after going home for review. Prior to this, the neurovascular specialist nurse will call you two to three weeks following your discharge from hospital.

Often further imaging is required following your treatment with a CT or MRI.