Cerebrovascular and Endovascular Neurosurgery

Cerebrovascular neurosurgery (CVNS) is a subspecialty of neurosurgery that deals with the medical evaluation and surgical treatment of diseases of the vasculature of the brain and spinal cord.

Diseases treated and therapeutic options include:

• Aneurysms
• Arteriovenous malformations (AVMs)
• Arteriovenous fistulas (AVFs)
• Atherosclerotic carotid disease
• Atherosclerotic intracranial vaso-occlusive disease
• Neurointerventional/endovascular neurosurgery
• Endovascular coiling
• Endovascular stenting and/or angioplasty
• Use of liquid embolic agents
• Microsurgical clipping

Endovascular neurosurgeons use radiological imaging and catheter technologies to provide patients with minimally invasive treatment options for aneurysms, arteriovenous malformations, and occlusive vascular diseases.

Endovascular therapy options include:

• Coiling or “embolization”. This can include use of specialized stents to help treat aneurysms
• Use of liquid embolic agents

Moneeb Ehtesham, MD

Dr. Ehtesham’s interests include all aspects of general neurosurgical disorders, with an emphasis on cerebrovascular neurosurgery, complex spinal pathology and brain tumors. He offers exceptional care to patients throughout the region with experience and advanced training in neurointerventional/ endovascular neurosurgery.

Dr. Ehtesham formerly served as Assistant Professor of Neurological Surgery at Vanderbilt University in Nashville, Tennessee. He also directed Vanderbilt’s neurosurgery research laboratory and was recognized with the “Young Investigator” award from the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

Brenton Coger, MD

For more information or to schedule an appointment, call 417-820-5150.

Treatment Options for Cerebral Aneurysms

There are three treatment approaches for people diagnosed with a cerebral aneurysm:

1. Medical Monitoring - This represents a non-surgical option typically only considered for the treatment of unruptured intracranial aneurysms.  These patients choose to work closely with their physician to monitor their aneurysm with periodic imaging (MRA, CT Scan or conventional angiography). However, because the nature of aneurysm rupture is not completely understood, this approach is not without risk because even aneurysms of a small size may rupture.
2. Open Surgery, Clipping- This is an open surgical treatment that involves a neurosurgeon clipping an aneurysm after creating a “craniotomy” or surgical opening in the skull. This is considered a complex surgery due to the size of the needed incision and the careful dissection of surrounding brain tissue. Aneurysm clips are available in various sizes and shapes and the choice depends upon the size and location of a patient’s aneurysm.
3. Endovascular, Coiling- Coiling is generally considered a less invasive approach that involves a small incision, created for the insertion of a catheter near a patient’s hip. After the catheter is inserted, the endovascular neurosurgeon navigates through the blood vessels and packs coils into the aneurysm to block the blood flow. The idea is to prevent blood from flowing into the aneurysm to lower the risk of rupture. Endovascular coiling requires that a neurosurgeon complete additional training in endovascular techniques. 

Which treatment option is best?

There are many factors to consider, such as the size and shape of your aneurysm.  Choosing a treatment option is a discussion to have with your neurosurgeon. Ask questions and discuss the benefits of each treatment option.