Neurosurgery is speciality in which surgery that focuses on the treatment of disorders and diseases of the brain and nervous system. Radiology is a medical speciality that uses various radiology techniques to diagnose and treat ailments and diseases.

Here we are going to discuss what is pin hole surgery or neuro-endovascular treatment in neurosurgery? How it is done ?  What are indications?

What is Endovascular neurosurgery?

Let us know what are synonyms – Neuroendovascular surgery, Interventional neuro radiology ,interventional neurosurgery.

Endovascular neurosurgery is a branch of neurosurgery with the help of small thin tubes,  wires and radiography is done  to identify and treat numerous central nervous system disorders and diseases.

Endovascular refers to “within a blood vessel.” The surgeon  employs radiological imaging to assist him or her in visualising the region of the body involved in the procedure.

These operations are referred to as “minimally invasive. Or pin hole surgery” This is due to the fact that they often require only puncture of the vessel with needle like an any other injection  as opposed to the bigger incision required for open surgery.

Interventional neuroradiology specialists must have training in Endovascular procedures. Which is usually after superspecialty training either in neurosurgery , neurology or Radiology.

What techniques are used by these specialists?

Endovascular neurosurgery techniques include the following:

Cerebral angiography- This is a radiological procedure that study the vessels blood in the brain.

Endovascular coiling- Aneurysm coiling – A brain aneurysm is a weakened region in the wall of a cerebral artery. Common Aneurysm are Acom, ICA aneurysm, Pcom Aneurysm. To stop blood flow, a surgeon inserts a very thin metal wire that creates a coil loop inside a brain aneurysm.

Angioplasty/stenting of the carotid artery- To open a constricted carotid artery, a small balloon and/or a tiny metal scaffold known as a stent are used. The carotid arteries carry oxygenated blood to the brain.

Acute stroke- in which blood clot or cholesterol plaques within the brain vessel is removed through groin vessel.

AVM is a artery venous malformation, to treat this condition  glue is used within the vessel.

Here are the few Endovascular procedures done by interventional neuroradiologist or Neuroendovascular surgeon:

  1. Mechanical Thrombectomy for Acute Stroke
  2. Carotid Stenting
  3. AVM Embolisation
  4. DAVF Embolisation
  5. Carotid Cavernous Fistula Management
  6. IPSS (Inferior Petrosal Sinus Sampling)
  7. Head and Neck Tumour Management
  8. Epistaxis Embolisation
  9. Spinal AVM,Dural Fistula Embolisation
  10. Spinal Tumour Embolisation
  11. Vertebral Tumour Embolisation
  12. Cerebral Angiogram
  13. Moya moya disease evaluation
  14. Wada Test.

Endovascular procedure are minimally invasive, with small pin hole can treat brain and spine disorders, no worry about blood loss, no opening of the skull and blood loss, less hospital stay, no scar over head. Disadvantages are groin site clot, contrast reaction, risk of blood   clot landing in main areas etc.


Endovascular neurosurgery, also known as interventional neuroradiology (INR) or Neuroendovascular surgery  is a type of brain surgery that is conducted from within blood vessels. Doctors thread catheters through blood vessels, then pass tiny devices through the catheters to perform surgeries.

Neuro wellness is a brain and spine care centre. If you are suffering from brain aneurysm, AVM,AVF, carotid cavernous fistula, need of carotid Stenting – any such problem, do visit for a healthy tomorrow as we provide the best treatment!

Dr. Ganesh Veerabhadraiah is a leading Neurosurgeon and Interventional Neuroradiology Specialist at Fortis Hospital, Bengaluru. With over 23 years of experience, he's renowned for his expertise in brain and spine surgeries.Trained at prestigious institutions like Manipal Hospital and University Hospital Zurich, Dr. Ganesh is dedicated to providing cutting-edge neurological care. Read More :