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Vascular Neurosurgery

We are specialized in the treatment of acute and chronic diseases of the brain vessels and the vessels of the spinal cord.

We guarantee optimal care for our patients by:

  • Close interdisciplinary cooperation of neurosurgeons, neuroradiologists, neurologists, and radiosurgeons
  • Latest device technology (biplanar angiography, hybrid surgery, 3 Tesla MRI, multislice CT, perfusion CT)
  • Specialised surgical equipment such as microsurgery, microdoppler, intraoperative ICG angiography, intraoperative neuromonitoring, intraoperative ultrasound

Our treatment offer:

Strokes and their consequences are one of the most common causes of medical emergencies in Germany. The cause is usually an acute vascular occlusion in the brain (ischemic stroke), as a result of which parts of the brain are no longer supplied with blood and are therefore damaged. Alternatively, so-called hemorrhagic strokes occur due to spontaneous bleeding into the brain tissue. Initial stroke care is provided by the Clinic for Neurology with its nationwide certified stroke unit.

In addition to hemorrhages, an acute complication of a stroke can also be a brain swelling that requires treatment. In individual cases, this can be treated surgically by a so-called hemicraniectomy (removal of a part of the bony roof of the skull) or the installation of external ventricular drains to drain off cerebrospinal fluid. The indication for a surgical procedure is set up by an interdisciplinary team in each individual case, taking into account current scientific standards and guidelines.

These are bleedings between the brain surface and the soft meninges - they usually require emergency clarification and treatment. The cause of bleeding are usually vascular bulges in the cerebral arteries - so-called aneurysms. In individual cases, however, these bleedings can also occur spontaneously without a clear source of bleeding being identified during the diagnostic process. In addition, other vascular diseases can be the cause of such bleeding.

After diagnosis, immediate intervention to eliminate the source of bleeding may be necessary. Here, surgical procedures (so-called clipping) or catheter-based endovascular procedures (so-called coiling) are used. Occasionally, surgery to relieve the pressure of a space-occupying haematoma or pathologically increased intracranial pressure may also be necessary.

Interdisciplinary emergency management and the possibility of accompanying intensive medical care are crucial for the prognosis and thus for the recovery of the patient. In addition to acute care, the identification and treatment of secondary circulatory disorders are also crucial for the outcome of treatment.

Aneurysms are basically distinguished between symptomatic - bled / bleeding aneurysms, e.g. in the case of subarachnoid hemorrhage - and non-symptomatic (so-called incidental) aneurysms, which are randomly identified during imaging. These are bulges in blood vessels that can usually develop as a result of a weakness of the vessel wall.

Symptomatic aneurysms usually require immediate therapy. In the case of aneurysms discovered by chance, the assessment of the possible bleeding risk in the individual case is crucial. This also includes the consideration of additional risk factors (high blood pressure, connective tissue diseases, smoking, increased blood lipids, etc.). After a new diagnosis of an aneurysm, we offer the entire diagnostic procedure for individual assessment.

The respective treatment recommendation will be coordinated interdisciplinary and discussed in detail with you. The specialists in neurosurgery and neuroradiology are available to you in an advisory capacity. After treatment we also organize and accompany you in individual follow-up care (follow-up angiography, follow-up MRI).

In addition to special spontaneous haemorrhages such as subarachnoid haemorrhage or haemorrhages in the context of a craniocerebral trauma, spontanous haemorrhages into the cerebrum or cerebellum are major emergencies in neurosurgery. Necessary diagnostic and therapeutic measures are set up on an interdisciplinary basis.

In addition to surgical relief of space-occupying bleeding via a craniotomy (removal of a section of the bony cranial roof), in individual cases a haematoma can also be treated via a minimally invasive drainage and the use of drugs that dissolve the blood clot (e.g. rtPA-lysis). This is especially true for bleeding into the nerve water spaces (so-called ventricles), as a result of which a build-up of nerve water (hydrocephalus) can lead to an additional complication. By dissolving these bleedings, a regulated outflow of nerve water can be ensured.

Irrespective of this, neurosurgery guarantees a constant availability of care for traumatic bleeding of any kind (e.g. epidural, subdural, intracerebral haematomas).

Arteriovenous malformation (synonym: AVM, angioma), dural arteriovenous fistula, cavernous haemangioma (cavernoma)

Arteriovenous malformations and cavernomas are vascular diseases that have been present since birth and develop over the course of life. Dural arteriovenous fistulas develop only in the course of life and are often caused by a traumatic event. This results in a kind of bypass (the so-called nidus) between arterial and venous vessels. The most frequent complication of these diseases are cerebral haemorrhages followed by seizure disorders or neurological deficits. In addition, they can be discovered by chance in modern imaging. Depending on the anatomical formation of the respective vascular malformation, various forms of therapy are available: endovascular, catheter-based techniques (coiling, embolization), surgical treatments (clipping, resection of the nidus), radiosurgery (e.g. gamma knife therapy). The aim of the respected therapy or a combination of different methods is usually the complete elimination of the vascular disease.

Cavernomas are vascular malformations that can occur in many tissues. It is a vascular disease with little blood flow, which is based on the constant remodelling and regeneration of the smallest vessels. They are often diagnosed incidentally, but they can also become symptomatic through neurological complaints (epileptic seizures, functional disorders such as paralysis, sensory disturbance, speech disorder). A major complication is spontaneous haemorrhage. A symptomatic cavernomas do not generally require surgery.

Close contact between blood vessels and cranial nerves near the brainstem can lead to symptomatic compression syndromes such as trigeminal neuralgia or facial hemispasm. Relevant compression of vascular or nerve strands can also occur in the peripheral nervous system (e.g. cervical rib syndrome, costoclavicular syndrome).

In addition to symptomatic therapy with medication, surgical treatments that eliminate the vascular nerve conflict (so-called microvascular decompression, Jannetta's procedure) can also be used. If necessary, vascular and thoratic surgeons are available as well.

In addition to direct emergency care, we maintain an intensive exchange with other hospitals via the Western German Teleradiology Network.

You can contact us at any time during our office hours. This also applies, of course, if you wish to obtain a second opinion. In addition to immediate diagnosis, your medical findings are crucial and will influence the choice of therapy. Our aim is to establish an optimal medical treatment plan for you on the basis of current scientific standards.