Neurointerventional Surgery involves minimally invasive, catheter-based treatments for the brain and spine.
The procedure involves inserting a 2-millimeter diameter catheter through an incision in the wrist or groin. Although most practitioners prefer the groin approach, Dr. Sabareesh Natarajan specializes in wrist access, which he has mastered over many years. His extensive experience makes him one of the leading experts in this technique nationwide.
Benefits of Catheter-Based Treatment Through the Wrist
Dr. Natarajan recommends using wrist-based catheter treatment when feasible, as it provides multiple advantages over groin access. These include a reduced risk of complications, no requirement for bed rest post-procedure, faster recovery times, and earlier discharge from the hospital.
Neurointerventional Procedures
Dr. Natarajan offers several different neurointerventional procedures, including the following.
Diagnostic Cerebral Angiograms
Diagnostic cerebral angiograms are usually outpatient procedures that last under an hour. During the process, patients receive IV sedation. A catheter is inserted from the wrist or groin, guided by X-ray, up to the neck. Dye is then injected into the catheter, making the blood vessels visible on X-ray.
This test assesses the blood vessels and helps diagnose conditions such as aneurysms, blood clots, and other issues. It can also evaluate spinal blood vessels to detect vascular disease or tumors.
Patients can typically go home about an hour after the procedure if done through the wrist, or within three hours if performed via the groin. Most can resume normal activities the next day.
Carotid Artery Stenosis Treatment
Carotid artery stenosis is the narrowing of the carotid artery in the neck, often detected through a carotid doppler or CT angiogram. Some patients have no symptoms, while others may experience a transient ischemic attack or stroke caused by reduced blood flow. In certain cases, a plaque in the artery can dislodge a clot into the brain, leading to a stroke.
For patients with symptomatic carotid artery stenosis, Dr. Natarajan usually recommends treatment if the artery is narrowed by 50% or more. For asymptomatic patients, treatment is advised if the narrowing reaches 70% or more.
There are several treatment options for carotid artery stenosis:
- Carotid endarterectomy – An incision is made in the neck to remove the plaque from the artery.
- Carotid stent – A stent is inserted through the wrist or groin using minimally invasive X-ray guidance.
- Transcarotid artery revascularization (TCAR) – During this procedure, a stent is placed through a cut in the neck instead of through the wrist or groin.
In most cases, Dr. Natarajan can place a stent without making a neck incision. His extensive neurointerventional expertise and years of experience allow him to perform the procedure with minimal risk of complications.
Middle Meningeal Artery (MMA) Embolization for Subdural Hematoma
Subdural hematoma is a condition that often develops with age. As the brain shrinks over time, extra space forms between the brain and skull. If a person hits their head or suffers trauma, bleeding can occur in this space. Over time, the blood builds up, putting pressure on the brain. Symptoms include severe headaches, neurological issues, gait problems, balance and coordination difficulties, or seizures.
Many patients with subdural hematomas are on blood thinners like antiplatelets or anticoagulants to prevent strokes and heart issues. This can increase the risk of bleeding and complicate treatment.
Traditionally, treatment involved craniotomy—opening the skull to drain the blood and placing a drain in the space. Patients often stayed in the ICU and had to stop anticoagulants.
In the past decade, Dr. Natarajan has started performing middle meningeal artery embolization, a less invasive procedure. It involves guiding a catheter through the wrist or groin into the artery feeding the brain membranes. An agent is injected to block the artery, and any remaining bleeding is absorbed over 6-8 weeks. This approach reduces recurrence risk and allows patients to continue blood thinners.
If neurological symptoms are severe, Dr. Natarajan usually performs a small craniotomy to reduce pressure first, then completes the embolization. Since the full effects take 6-8 weeks, combining these methods helps speed symptom relief.
Venous Sinus Stenting for Pseudotumor Cerebri and Pulsatile Tinnitus
Venous sinus stenting is performed to treat pseudotumor cerebri, also called idiopathic intracranial hypertension, and pulsatile tinnitus.
Pseudotumor Cerebri
Patients with pseudotumor cerebri experience headaches and increased intracranial pressure, which can lead to blindness. Traditional treatments include taking Diamox to lower head pressure, placing a shunt to drain excess cerebrospinal fluid, or making small incisions around the optic nerve to relieve pressure. However, these methods often have high complication rates.
Dr. Natarajan offers an alternative: venous sinus stenting. Most patients with pseudotumor cerebri have venous stenosis, a narrowing of the brain’s veins, causing elevated pressure. During the procedure, Dr. Natarajan inserts a stent via the venous system to widen the narrowed areas or reduce pressure differences. This approach frequently cures the condition, allowing patients to stop taking Diamox.
Pulsatile Tinnitus
Patients with pulsatile tinnitus regularly perceive a “whooshing” noise in their ear. Often, they also have venous sinus stenosis, which can be effectively treated through venous sinus stenting.
Arteriovenous Malformations and Fistulas
Arteriovenous malformations and arteriovenous fistulas of the brain are abnormal connections between arteries and veins that can cause hemorrhage. There are three treatment options for these conditions:
- Open surgery
- Endovascular embolization
- Radiation treatments
Dr. Natarajan is skilled in all three treatment options, enabling him to choose the most appropriate method for each patient’s specific condition. Generally, for venous malformations, surgical removal of the lesion is preferred when possible. Endovascular embolization reduces blood flow within the malformation, making surgery easier. Radiation therapy is reserved for malformations located in brain areas where surgical resection might pose significant risks.
Stroke & Stroke-Related Conditions
Dr. Natarajan works at comprehensive stroke centers in San Diego, including Sharp Grossmont, Chula Vista, and Memorial Hospital. At these locations, he can promptly reach patients and identify clots. He uses a catheter to remove the clot and restore blood flow. Timely treatment is crucial in these cases; with over 20 years of experience, Dr. Natarajan has performed thousands of catheter-based procedures efficiently.
Neurointerventional Surgery in the San Diego Bay Area
Dr. Sabareesh Natarajan brings over 20 years of expertise in neurointerventional treatments. He is among the few specialists skilled in wrist-based catheter procedures, which typically allow for faster recovery than groin access. To schedule an appointment at one of our four San Diego clinics, call (619)-984-6969 or complete our appointment request form.
