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The group of so-called neurovascular diseases includes the following clinical pictures, which can manifest themselves with acute or slowly occurring symptoms. Individual areas of the brain or spinal cord can be temporarily or permanently affected by bleeding, swelling or circulatory disorders.
- Brain aneurysms
- Cerebral vascular malformations (AVMs, cavernomas, etc.)
- Cranial dural arteriovenous fistulas (CDAVF)
- Spinal vascular malformations and spinal dural arteriovenous fistulas (SDAVF)
- Acute ischemic stroke
- Narrowing (stenosis) of the neck and brain vessels
- Accidental (traumatic) and spontaneous arteriovenous fistulas of the head and neck
- Hemangiomas and vascular malformations of the head, face and neck
For diagnosis, we mostly use computed tomography angiography (CTA), magnetic resonance imaging (MRI) and angiography (MRA) and catheter angiography (DSA).
Although non-invasive CTA and MRA can visualize the blood vessels of the head, neck and spinal cord, the details are usually not sufficient for optimal treatment planning in cases of aneurysm or vascular malformation. As a rule, catheter angiography is necessary. In this procedure, a catheter is inserted into an artery in the groin and guided from there to the blood vessels in the neck. After injecting a contrast agent, details of the vascular system of the brain are shown in three dimensions on the subsequent X-ray images, allowing the appropriate type of treatment to be determined.
We treat the entire spectrum of vascular diseases in the head, neck and spinal cord. Our team treats emergencies such as subarachnoid hemorrhages from burst (ruptured) aneurysms, intracerebral and subdural hematomas and acute ischemic strokes of large cerebral vessels. If an unruptured aneurysm or other vascular malformation is discovered, it can be treated electively, i.e. planned, if necessary.
Cerebral vascular diseases require an interdisciplinary, individualized treatment plan. This may include interventional (also known as embolization), surgical or a combination of treatment methods.
An aneurysm is a pathological dilation or bulging of the vessel wall of cerebral arteries. A sudden rupture of the aneurysm wall (aneurysm rupture) can lead to a life-threatening cerebral hemorrhage. This special form of bleeding is called subarachnoid hemorrhage (SAH) and is an acute emergency situation. However, brain aneurysms can also be detected by chance during a CT scan or MRI of the brain (e.g. when investigating headaches) before a rupture occurs.
Every year, up to 700 people in Switzerland suffer such a hemorrhage. Unfortunately, the prognosis of an aneurysm rupture is very unfavorable. Approximately 20-30% of those affected die and 20-40% of survivors suffer permanent neurological impairment. For these reasons, recognizing, monitoring and treating an existing aneurysm is of great importance.
Most aneurysms do not cause any symptoms and are therefore asymptomatic. The first indication of a cerebral aneurysm may be a hemorrhage. The symptoms that occur with an SAH include a sudden onset of severe headaches, nausea and vomiting as well as loss of consciousness.
The treatment of ruptured aneurysms can include both endovascular and surgical operations and requires intensive interdisciplinary collaboration between neurosurgeons, neuroradiologists, neurologists and intensive care physicians in order to determine the optimal therapy for each individual patient. During the surgical operation, a small clip is placed at the neck of the protrusion to prevent bleeding.
In endovascular surgery (embolization), a minimally invasive procedure for treating aneurysms, microcatheters, either platinum coils or other intrasaccular implants, are inserted into the aneurysm using a microcatheter advanced from the groin. Depending on the need, with the help of a stent, flow diverter or balloon, all of which help to eliminate the aneurysm.
The most common vascular malformations are arteriovenous malformations (AVMs) and cavernomas (CMs) of the brain and spinal cord. Other less common malformations include developmental venous anomalies (DVAs) or venous angiomas, capillary telangiectasias and other mixed and more complex malformations.
An arteriovenous malformation (AVM) is an - often congenital - malformation of the blood vessel system that affects the central nervous system. An arteriovenous malformation (AVM) carries the risk of a cerebral hemorrhage, but can also lead to epileptic seizures, headaches and other neurological disorders. Therefore, even in the case of a newly diagnosed AVM, the next steps must be planned and discussed in detail. The treatment of an AVM is determined individually for each patient and can include surgical, interventional neuroradiological and radiotherapeutic measures.
A dural arteriovenous fistula can occur in the head or in the spinal column. Dural arteriovenous fistulas (DAVF) are pathological connections between an artery and a vein in the meninges (dura mater), brain or spinal cord.
These fistulas often develop after a thrombosis of a vein in the nervous system, with or without previous trauma. The symptoms can be benign such as tinnitus or aggressive in the form of bleeding. Depending on the characteristics of each fistula, treatment or follow-up is recommended.
The treatment of DAVF can be interventional (more common) or surgical. In some cases, radiotherapy is also an option.
In Switzerland, around 16,000 people suffer a stroke, also known as a cerebrovascular accident, every year. This can be triggered either by the blockage of a cerebral vessel and/or by a hemorrhage. Common causes are circulatory disorders with the formation of clots or high blood pressure.
A stroke is also an acute emergency situation in which a diagnosis must be made quickly and the appropriate treatment initiated. This depends on the type of stroke. In the case of a stroke caused by a vascular occlusion, lysis therapy is usually carried out, in which blood clots are dissolved using medication or intervention (thrombectomy). Hemorrhages that exert great pressure on the brain tissue due to their space-occupying effect, however, often have to be treated surgically.
