Neurointerventional Radiology, Interventional Neuroradiology, or Endovascular Neurosurgery, is a subspecialty combining minimally invasive techniques in Radiology and Neurosurgery to treat vascular conditions of the central nervous system — the brain, spinal cord, head and neck. Our experienced Neurointerventional Radiologists are certified by the American Board of Radiology and considered international experts in the field. They have performed thousands of minimally invasive procedures and collaborate to provide excellent patient care.
We are Northern Virginia’s leaders in Neurointerventional Radiology, offering new therapies and technologies to treat even the most complex cases. Our goal is to provide you with exceptional service and the most advanced, evidence-based medical care available – delivered in a welcoming, friendly environment. All procedures are performed in our state-of-the-art neurological suite located at our partner hospital, Inova Fairfax in Fairfax, VA.
Your satisfaction is important to us. We treat every patient with dignity, respect and compassion. Our individualized approach means we work closely with you to develop a treatment plan that meets your goals and promotes healing and recovery.
Please call us at 703.776.3030 to schedule an appointment.
Below is a list of conditions our physician's specialize in. Click on any of the conditions and procedures below to learn more.
A brain aneurysm is a weak spot of a blood vessel in the brain seen as an abnormal bulge. Brain aneurysms can leak or rupture, resulting in a brain bleed (hemorrhage) which can result in severe, permanent disability and/or death. A ruptured aneurysm is considered a life-threatening emergency and requires immediate medical attention and treatment. Symptoms include a sudden, severe headache, nausea and vomiting, neck pain, blurred vision or loss of consciousness.
Endovascular Embolization is a minimally invasive procedure to treat brain aneurysms. The Neurointerventional Radiologist feeds a soft, flexible tube called a catheter into the brain aneurysm via a small hole made in an artery in the groin. Embolization of the aneurysm is then accomplished by various techniques, including the placement of platinum coils inside the aneurysm, thereby blocking blood flow to the aneurysm, or placement of a flow diverting device (Pipeline Device) across the aneurysm in order to direct blood flow away from the aneurysm.
These techniques are performed under general anesthesia and take just a few hours.
Endovascular Embolization can be used to treat both ruptured and unruptured brain aneurysms. The decision to treat an unruptured brain aneurysm that is not causing symptoms is based on many factors, including the size, shape and location of the aneurysm, your overall health and your family history.
An arteriovenous malformation (AVM) is a tangle of blood vessels in the brain that bypasses normal brain tissue and diverts blood from the arteries to the veins. AVMs are extremely rare, affecting less than one percent of the population. Most are congenital (present at birth), but some form later in life. AVMs put pressure on the blood vessels and raise your risk of seizure or stroke.
AVMs can cause symptoms, such as seizure or stroke, or can be asymptomatic and only discovered during a brain scan for another health issue. Once diagnosed, the decision to treat an AVM is based on its size, location, your overall health and the risk of future complications if left untreated.
Endovascular Embolization is a minimally invasive procedure to treat an AVM. The Neurointerventional Radiologist feeds a soft, flexible catheter to the site of the AVM via a sheath inserted in an artery in the groin and injects a glue-like substance to block blood flow to the malformed vessel. Although in some cases Embolization can be a successful stand-alone treatment, Endovascular Embolization is often used in combination with surgical resection or radiation for the best result.
An arteriovenous fistula (AVF) is a tangle of blood vessels with abnormal arterial and venous connections, similar to an AVM. AVFs are more likely to develop later in life and are often found in the brain or spine. Like AVMs, they raise your risk of seizure and stroke.
Treatment depends on the fistula’s size, location and whether or not it is causing any other health problems. If the AVF is small, monitoring may be sufficient. If it is larger and potentially troublesome, your doctor may recommend Endovascular Embolization.
Carotid artery disease occurs when one or both of the carotid arteries in the neck become narrowed or blocked by plaque. The carotid arteries are two large blood vessels that supply blood to the brain. When they become obstructed, one is at increased risk of stroke.
Stroke is a medical emergency! Treatment is most effective when given within the first few hours, so it is important to recognize the symptoms and act quickly. If you suspect a stroke, call 911 immediately. EMS can begin vital treatment in the ambulance. Stroke symptoms include:
Carotid Artery Stenting is a minimally invasive technique to treat severely narrowed or blocked carotid arteries. In this procedure, the Neurointerventional Radiologist inserts a catheter through the groin and threads it to the neck. A small balloon is inserted into the blocked artery and inflated. A slotted metal tube called a stent is then placed inside the artery in the area of the narrowing to hold it open. The stent remains inside the artery permanently.
Cerebral Angiography is a minimally invasive diagnostic test to detect abnormalities in the blood vessels of the head and neck. In this procedure, the Neurointerventional Radiologist inserts a tube called a catheter into an artery in your leg and uses X-ray guidance to advance the catheter up through the abdomen, chest, and into the neck to the artery to be examined. Once there, contrast material (dye) is injected through the catheter and several sets of X-rays taken. The catheter is then removed. The technique is performed under local anesthesia and minimal sedation (as it is not painful) and takes less than an hour. It can detect or confirm conditions such as aneurysm, AVM, AVF, carotid artery disease or other abnormalities within the blood vessels of the brain.
Spinal Angiography is a minimally invasive diagnostic test to detect or confirm abnormalities in the blood vessels in your spine. In this procedure, the Neurointerventional Radiologist inserts a catheter into an artery in your leg and uses X-ray guidance to find the area to be examined. Once there, contrast material (dye) is injected through the catheter and several sets of X-rays taken. The catheter is then removed.
The procedure takes between one and three hours and is usually performed under general anesthesia to ensure you remain perfectly motionless for best results. It is used to diagnose conditions such as AVMs, AVFs of the spinal cord. If a problem is found, the physician may also perform an Endovascular Embolization to treat it.
Tumors of the head and neck often develop a significant blood supply, raising the risk of excessive bleeding during surgical removal. Neurointerventional Radiologists use Endovascular Embolization to cut off the blood supply to these tumors, enabling a quicker, simpler surgery with far less blood loss.
The minimally invasive embolization procedure is performed several days prior to surgery. First, the Neurointerventional Radiologist performs a Diagnostic Angiogram to identify the source of the tumor’s blood supply. Then, a soft, flexible catheter is fed via a sheath inserted inside an artery of the groin to the tumor site and a various substances, such as small particles or glue, are injected to block the blood flow.
Officially known as the Intracarotid Sodium Amobarbital Procedure (ISAP), this test often goes by the nickname Wada, after the physician who first performed it, Dr. Juan Wada. It is done before certain types of brain surgery to determine which side of the brain controls language function and which side has better memory function. Results help the neurosurgeon facilitate operative planning and improve the surgical result.
The Neurointerventional Radiologist injects a short-acting anesthetic into your right or left carotid artery, putting one side of your brain to sleep for a few minutes. When EEG (brain wave) recordings confirm that your brain is asleep, a neurological exam is performed by your Neurologist, who is also present. Different objects and pictures are shown. When the anesthetic wears off, you will be asked what you saw. The same procedure is repeated on the other side.
An ischemic stroke occurs when a blood vessel feeding the brain suddenly becomes clogged, cutting off vital blood flow and oxygen supply to that area of the brain. Neurointerventional Radiologists are able to quickly enter the artery of the groin and drive a long tube called a catheter to the area of blockage. Once there, the Neurointerventional Radiologist is then able to open up the blockage by using a vacuum device to aspirate the blood clot (Penumbra System) or using a self-expanding stent-retriever (Solitaire or Trevo). Whatever method is used, the goal is the reestablishment of blood flow past the area of blockage, thereby limiting damage to the brain and allowing for better recovery.
Stroke is a medical emergency! Treatment is most effective when given within the first few hours, so it’s important to recognize the symptoms and act quickly. If you suspect a stroke, call 911 immediately. EMS can begin vital treatment in the ambulance.
Stroke symptoms include:
Endovascular Embolization is a minimally invasive treatment to block uncontrolled bleeding of the head or neck due to trauma, tumors or even severe nosebleeds. In this technique, the Neurointerventional Radiologist inserts a catheter into an artery in the groin and guides it to the blood vessels involved. Contrast dye is injected through the catheter and X-rays taken to identify the problem. The physician then injects small particles or glue which acts to seal the vessel and stop the bleeding.
The procedure is performed under local or general anesthesia and takes approximately one hour, depending on the complexity of the problem.
Vertebral compression fractures (VCF) are breaks in the bones (vertebrae) that form the spinal column. The most common cause is osteoporosis, but tumors, trauma and other medical conditions can also cause VCFs.
Kyphoplasty and Vertebroplasty are performed under sedation and usually take less than 1 hour. You and your Neurointerventional Radiologist will determine the treatment that is best for you.
What do I need to bring to my appointment?
Please bring the following to your appointment:
What do I need to do before my procedure?
Your insurance company may require pre-certification for your procedure. Contact your insurance company well in advance to ensure coverage.
In addition, you may need to obtain medical clearance from your primary care doctor or cardiologist.
Our office will help you arrange any required lab tests.
Our nurse will be in touch with you to discuss special instructions, including medications.
Let us know if you:
NOTE: If you take insulin for diabetes, ask your primary care doctor how much to take, since you will be without food or liquid after midnight on the day of your surgery.
If you take aspirin or Plavix, do not stop taking these medications unless we instruct you to do so. NOTE: If you take Plavix, you cannot take medications called proton pump inhibitors (PPIs). PPIs include Prevacid, Prilosec, Zegerid, Protonix and Aciphex. If you have been prescribed a PPI, please contact your primary care doctor to discuss alternatives.
Be sure to make arrangements to have someone drive you back and forth to the hospital.
On the day of your surgery:
What should I expect after my procedure?
After your procedure, you will be asked to lie flat for about three hours and avoid moving your legs. This will help prevent bleeding at the puncture site in your groin area. If your procedure does not require an overnight stay, your total time from check-in to discharge will be approximately five to seven hours. You must make arrangements for a ride home from the hospital. Patients cannot take a taxi or public transportation home.
If your procedure requires an overnight stay, you will most likely spend the night in the neuroscience intensive care unit (NSICU) and be discharged the following afternoon. When you are discharged, we will give you instructions that include limitations on activity. For example, you should not lift anything greater than 10 pounds for one week.
How do I get more information?
If you have questions or concerns, please call 703.776.3030.
Randolph S.Dr. Greenberg, I write to express my deep appreciation for your treatment of my wife Noel following her aneurysm repair. It is difficult to put into words the extent to which your care exemplifies the best of the medical profession. Thank you for what you do. We feel very fortunate indeed that her care is in your hands.
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