What is Endovascular Surgical Neuroradiology (ESNR)? Endovascular surgical neuroradiology is a recently developed specialty that has undergone rapid evolution during its short existence. Even the name for this specialty has undergone an evolution that reflects the various medical disciplines that have contributed to its growth: interventional neuroradiology, surgical neuroradiology, endovascular neurosurgery, and others. The official term approved by the American Society of Interventional and Therapeutic Neuroradiology (ASITN) is now endovascular surgical neuroradiology.

Originally developed by radiologists and neurological surgeons, less invasive techniques were developed to treat patients for whom conventional surgical techniques had failed or for patients in need of treatment when no good conventional surgical options existed. Endovascular surgical neuroradiology as a discipline has benefited enormously by developments in computer technology and the manufacture of “microcatheters” and other tools to navigate the brain’s circulation. As surgical treatment in all parts of the body has become more “minimally invasive”, vascular neurosurgery is becoming less invasive, less traumatic, and but in many circumstances more effective for treating patients with cerebral vascular and spinal vascular disease.

Brief history of ESNR
Radiology has traditionally been a consulting service. Radiology as a medical specialty developed after the discovery of X-rays or Roentgen rays. Originally the purview of photographers, x-rays allowed physicians to create images of internal anatomy of the body without surgery. Thus, the field of radiology was started. Radiologists are specially trained physicians who are regularly consulted to perform diagnostic procedures that have become the cornerstone of all medical diagnosis. While physical examination is the first step in the evaluation of any patient, such examination skills cannot in any way match the precision and accuracy of modern medical imaging to diagnose and characterize illness without the need for exploratory surgery.

Interventional radiology is a subspecialty discipline of radiology. Initially using x-ray fluoroscopy (“real-time” x-ray cinameatography to monitor movement inside the body) and angiography (injection of x-ray contrast (x-ray “dye”) to obtain pictures of blood vessel anatomy), radiologists developed techniques to treat patients who were either too sick for standard surgical procedures, had failed standard surgical procedures, or for whom there was no safe surgical procedure. Now, radiologists use not only x-ray fluoroscopy but also ultrasound, computed tomography (CT), and even magnetic resonance imaging (MRI) to guide their way through the body and visualize their operative procedures without making a skin incision to see inside the body. Using tiny catheters and guiding wires measuring a small fraction of an inch in diameter, the tools used to perform these procedures have improved dramatically in the last decade. There are very few places in the body that can no longer be reached using modern techniques and new these devices. As medical science, patients as consumers of medical treatment, and industry recognize the power of these endovascular techniques, there has been a surge of interest and investment into the devices and other equipment needed to perform minimally invasive procedures. New technologies are coming to market at a rapid pace. Now, the spectrum of disease amenable to endovascular treatment, in many cases endovascular cures, increases annually, if not monthly.