The specialty of Endovascular Surgical Neuroradiology has evolved rapidly over a relatively short period of time. Originally developed by radiologists and neurosurgeons, these less invasive approaches to treatment (within the blood vessels) were developed to treat patients for whom no good open surgical option existed, or when conventional surgery had failed.
As a result of rapid advancement in computer technology and the development of new devices, the scope of this specialty has broadened from treating only those who could not be treated and helped otherwise, to become a mainstream of everyday practice, replacing certain forms of conventional surgery. Throughout this progression, the name of the specialty has evolved as well: interventional neuroradiology, surgical neuroradiology, endovascular neurosurgery, endovascular surgery, and endovascular therapy.
Major milestones of this specialty are exemplified through the evolution of treatment of brain aneurysm.
1979 – Fedor Serbinenko, a Russian neurosurgeon reported his experience with endovascular techniques using embolization of aneurysm. He created balloons on his own kitchen table.
1980s – Balloon embolization became the procedure of choice for otherwise untreatable brain aneurysms; results however were poor.
Late 1988 – Dr. Guido Guglielmi arrived at the University of California in Los Angeles to join Dr. Fernando Vinuela, and together they began research on what was to become the Guglielmi Detachable Coil (GDC).
March 1990 – The world’s first patient is treated with GDC coils at UCLA Medical Center.
1991-1995 – Early series in the United States using only high risk surgical patients.
1995 – FDA approval for the CDC coils; wider use begins.
1988-1989 – During this two-year period at UCLA, I treated close to 200 aneurysms with coils. We led this change in the United States and around the world with this cutting-edge technology.
2001 – Results of a European study lay to rest the dispute between coiling vs. conventional surgery. More than 1000 patients with ruptured aneurysm were treated and randomized. Results: Coiled patients did better when compared to open surgical patients. Following this discovery, the trial ended.
Technological advancement did not stop, however, with the emergence of advanced coiling. Since 2001, 3D imaging, balloon assisted coiling techniques and stent assisted coiling has emerged.
