- Interventional neuroradiology
Interventional Neuroradiology (INR)/Neurointerventional Surgery (NIS) is an (ACGME) Accreditation Council for Graduate Medical Education accredited medical subspecialty specializing in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and spine. While NIS can be ACGME accredited, fewer than 5 programs in the U.S. are actually accredited. First accredited in 2000, there are currently more than 500 individuals in the United States who have an active interest and special competency in this field.
The technique that constitutes the basis for angiographic neurointerventions, and thus, interventional neuroradiology, was first developed in 1927 by the Portuguese physician and neurologist Egas Moniz at the University of Lisbon to provide contrasted x-ray angiography in order to diagnose several kinds of nervous diseases, such as tumors, coronary heart disease and arteriovenous malformations. He is usually recognized as one of the pioneers in this field. Moniz performed the first cerebral angiogram in Lisbon in 1927.
In 2007, the specialty changed its name from Interventional Neuroradiology to Neurointerventional Surgery. The American Society of Interventional & Therapeutic Neuroradiology (ASITN) changed its name to Society of Neurointerventional Surgery (SNIS). Others have proposed redefining the field as "endovascular surgical neuroradiology." Closely aligned is the Society for Vascular and Interventional Neurology (SVIN), founded in 2006 to represent a society of persons interested in the innovative treatment of cerebrovascular and other neurological disease recently the Society of Minimally Invasive Neurological Therapeutic procedures (SMINTP), founded in 2009 to represent a society of specialists who gathered from Europe and Middle East to push forward the field in the developing regions by educating juniors and promoting research in this areas.
Preparatory requirements for a fellowship in INR/NIS include successful completion of a residency in Radiology, Neurosurgery, or less commonly Neurology and additional training depending on the given field. Neurologists must complete additional fellowship training in neurovascular disease or neurocritical care in order to qualify to train in a Neurointerventional fellowship. Radiologists usually complete a fellowship in diagnostic neuroradiology prior to a Neurointerventional fellowship.
Neurointerventional fellowships are variable in length, but last from 1-3 years with a focus on the integration of clinical management and performance of endovascular surgeries of the conditions/diseases listed below. Many fellowships require a second year of training which allows participants to further hone their technical skills and assert a greater degree of influence in clinical management of patients with diseases of interest.
Diseases & Conditions
The following is a list of diseases and conditions typically treated by neurointerventionalists.
- Cerebral aneurysm
- Brain arteriovenous malformation (AVM)
- Carotid-cavernous fistula (CCF)
- Dural arteriovenous fistula
- Extracranial (brachiocephalic) atherosclerosis
- Extracranial (head and neck) and paraspinal vascular malformations
- Head and neck tumors
- Intracranial atherosclerosis
- Juvenile nasopharyngeal tumor
- Spinal vascular malformations
- Traumatic vascular lesions
- Vertebral body tumors
- Vertebral body compression fractures
- ^ Lakhan SE, Kaplan A, Laird C, Leiter Y (2009). "The interventionalism of medicine: interventional radiology, cardiology, and neuroradiology". International Archives of Medicine 2 (27): 27. doi:10.1186/1755-7682-2-27. PMC 2745361. PMID 19740425. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2745361.
- Society for Vascular and Interventional Neurology (SVIN)
- Society of Neurointerventional Surgery (SNIS)
- American Academy of Neurology (AAN)
- American Association of Neurological Surgeons
- Congress of Neurological Surgeons
- American College of Graduate Medical Education (ACGME)
- Interventional Neuroradiology at Johns Hopkins Medicine
- Society of Minimally Invasive Neurological Therapeutic procedures (SMINTP)
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