The Neurointerventional Surgeon

This field is the epitome of collaboration. Practitioners can come from one of three core specialties, after which they complete additional fellowship training (1-2 years) in neurointervention:

1. Endovascular Neurosurgeons: Neurosurgeons who specialize in this approach.
2. Interventional Neurologists: Neurologists who specialize in procedures.
3. Interventional Neuroradiologists: Radiologists who specialize in navigating the nervous system using imaging.

They work as part of a multidisciplinary team including neurologists, neurosurgeons, radiologists, and critical care specialists.

How is it Different from Traditional Neurosurgery?

Common Conditions Treated

Neurointerventional techniques are primarily used for vascular disorders of the nervous system:

1. Brain Aneurysms: A weak, bulging spot on a brain artery.
   • Treatment: Endovascular Coiling or Flow Diversion (using a stent-like device). The goal is to seal off the aneurysm from inside the blood vessel to prevent it from rupturing.
2. Arteriovenous Malformations (AVMs): A tangle of abnormal blood vessels connecting arteries and veins.
   • Treatment: Embolization: Injecting a glue-like substance or tiny particles through the catheter to block the abnormal vessels and reduce blood flow.
3. Ischemic Stroke (Clot): A blood clot blocking an artery in the brain.
   • Treatment: Mechanical Thrombectomy: The flagship procedure. A stent retriever is used to physically grab and remove the clot, or a suction device is used to aspirate it. This is a time-critical procedure that can reverse paralysis if done quickly.
4. Carotid Artery Stenosis: Severe narrowing of the neck arteries that supply blood to the brain.
   • Treatment: Carotid Artery Stenting: A metal mesh tube (stent) is expanded inside the narrowed artery to hold it open, often with a filter device to protect the brain from debris.
5. Vertebroplasty/Kyphoplasty: For painful spinal compression fractures (e.g., from osteoporosis).
   • Treatment: Medical cement is injected into the fractured vertebra to stabilize it and relieve pain.
6. Epistaxis (Severe Nosebleeds): When conservative measures fail.
   • Treatment: Embolization of the bleeding vessel.
7. Tumors: Certain vascular brain or spine tumors can be treated pre-operatively with embolization to reduce blood loss during subsequent surgical removal.

The Neurointerventional Procedure: A Step-by-Step Example (Thrombectomy)

1. Access: A small incision is made in the groin to access the femoral artery.
2. Navigation: A guidewire and a thin catheter are threaded through the arterial system, all the way up the aorta, into the neck arteries, and into the specific brain artery blocked by the clot. This is done under live X-ray guidance (fluoroscopy).
3. Treatment: A specialized device (a stent retriever or aspiration catheter) is advanced through the guide catheter to the clot.
4. Clot Removal: The device engages the clot, and the entire system (catheter + clot) is carefully withdrawn.
5. Confirmation: An angiogram (X-ray with contrast dye) is performed to confirm the blood flow has been restored.
6. Completion: The catheters are removed, and pressure is applied to the small puncture site in the groin.

Benefits of Neurointerventional Surgery

• Minimally Invasive: No large incisions or need to open the skull.
• Reduced Risk: Lower risk of infection and less blood loss compared to open surgery.
• Faster Recovery: Shorter hospital stays and quicker return to normal activities.
• Treatment of Inoperable Conditions: Offers options for conditions that are too risky or difficult to treat with traditional surgery.

Risks and Considerations

While safer than open surgery in many cases, it is not without risks, which can include:

• Bleeding or damage at the catheter insertion site.
• Damage to a blood vessel, causing a dissection or rupture.
• Blood clots forming on the devices.
• Stroke if a clot dislodges and travels to the brain.
• Allergic reaction to the contrast dye.
• Radiation exposure from the imaging guidance (though carefully monitored).

Neurointerventional Surgery Cost in India

The cost is highly variable, depending on the complexity of the procedure, the devices used (stents, coils, flow diverters), and the hospital’s infrastructure.

Summary: Estimated Cost Range

• Overall Range: ₹ 2,50,000 to ₹ 12,00,000+ (approx. $3,000 to $14,500+ USD)

Procedure-Wise Cost Breakdown

Factors That Significantly Influence the Cost

1. Type of Implant/Device: This is the biggest cost factor. Imported devices like flow diverters (e.g., Pipeline Embolization Device), specific stents, and specialized coils are extremely expensive and can alone account for 40-60% of the total bill.
2. Hospital Category: Premium corporate hospitals in metros (Delhi, Mumbai) charge significantly more than others. The cost covers the use of state-of-the-art biplane cath labs, which are essential for these procedures.
3. Surgeon’s Expertise: The fee of a highly renowned and experienced neurointerventionalist is a major component.
4. Complexity of the Case: A simple aneurysm coiling will cost less than treating a giant, complex aneurysm with multiple stents and coils.
5. Length of ICU Stay: These are critical procedures. The patient often requires intensive monitoring in a Neuro-ICU for several days post-procedure, which adds to the cost.
6. Emergency vs. Planned Procedure: An emergency thrombectomy performed at night or on a weekend may involve additional charges.

Best Hospitals for Neurointerventional Surgery in India

The “best” hospital depends on the specific condition, the expertise of the endovascular team, and the availability of advanced technology. The following hospitals are consistently ranked at the top due to their high volume of cases, excellent outcomes, and cutting-edge infrastructure.

Tier 1: Premier Institutes with Dedicated Neurovascular Programs

1. Medanta – The Medicity, Gurugram: Home to the Institute of Neurosciences, it is a leader in the field. Boasts a team of renowned endovascular neurosurgeons and neurologists and has some of the most advanced imaging and cath lab technology available.
2. All India Institute of Medical Sciences (AIIMS), New Delhi: The premier government institute. Offers world-class care at highly subsidized rates. Known for handling the most complex cases but has long wait times for non-emergency procedures.
3. Apollo Hospitals, Chennai: A pioneer in neurosciences in India. Has a very strong and experienced neurointerventional team and a very high volume of procedures, especially for strokes and aneurysms.
4. Fortis Memorial Research Institute (FMRI), Gurugram: Has a renowned Centre for Neurosciences with a dedicated stroke program and 24/7 availability for emergency thrombectomy. Known for its advanced technology and skilled surgeons.
5. Manipal Hospitals, Bangalore: Has a robust neuroscience department with a strong focus on comprehensive stroke care and neurointerventions.

Tier 2: Other Excellence-Driven Centers

1. Kokilaben Dhirubhai Ambani Hospital, Mumbai: Known for its advanced technology, 24/7 stroke response team, and excellent critical care facilities.
2. Global Hospitals, Mumbai & Chennai: Particularly strong in liver and multi-organ transplants, they also have advanced neuroscience institutes capable of complex neurointerventions.
3. Sir Ganga Ram Hospital, New Delhi: A trusted name in Delhi with a strong neurology and neurosurgery department and a good neurointerventional unit.
4. NIMHANS (National Institute of Mental Health and Neurosciences), Bangalore: A government-funded institute of national importance. Excellent for neuro care and research, with subsidized costs, but similar wait times to AIIMS.

How to Choose the Right Hospital: Key Considerations

• Multidisciplinary Team: The best centers have a dedicated Stroke Team and a Neuro ICU with 24/7 support from neurologists, neurosurgeons, neurointensivists, and rehabilitation specialists.
• Technology: Ensure the hospital has a modern Biplane Cath Lab with 3D rotational angiography. This technology is crucial for the precision and safety of these procedures.
• Surgeon and Team Volume: Ask about the number of procedures the team performs annually. High-volume centers typically have better outcomes.
• Emergency Response: For stroke, time is brain. Choose a hospital with a proven 24/7 acute stroke code system that ensures rapid imaging and treatment.
• Post-Procedure Care: Recovery involves intensive monitoring and rehabilitation. Ensure the hospital has a strong neuro-rehabilitation program.

Conclusion

Neurointerventional Surgery represents a monumental shift in treating some of the most critical neurological conditions. By offering a minimally invasive alternative to open brain surgery, it has revolutionized stroke care and the management of complex vascular lesions, significantly improving patient outcomes and quality of life. It is a field defined by precision, technology, and rapid innovation.