University Radiology has New Jersey's most experienced interventional neuroradiology team, serving patients with brain, spine and spinal cord disorders from throughout the tri-state area at Robert Wood Johnson University Hospital in New Brunswick.

Our interventional neuroradiologists include Sudipta Roychowdhury, MD, Director of Interventional Neuroradiology at Robert Wood Johnson University Hospital, Steven Schonfeld, MD, FACR, and Irwin Keller, MD, FACR. They work closely with Gaurav Gupta, MD, Director of Endovascular and Cerebrovascular Neurosurgery at Robert Wood Johnson University Hospital and Medical School.

Equipped with the latest, state-of-the-art technology, our team is known throughout the region for treating brain aneurysms, brain arteriovenous malformations (AVMs) and strokes in adults and children. Our team's experience includes several landmark cases in New Jersey, including:

• The first brain aneurysm coiling performed in New Jersey in 1997.
• The interventional (nonsurgical) treatment of an arrow accidentally tearing the middle cerebral artery in a child.
• The interventional treatment of one of the youngest patients of a venous stroke (age 5) and an arterial stroke (age 6).
• The interventional removal of a nail from the brain.
• The first neonatal vein of Galen malformation treated in New Jersey.
• Successful interventional treatment of a basilar artery stroke at 36 hours.
• The most state-of-the-art Pipeline™ Device embolization procedures performed for brain aneurysms in New Jersey.

Appointments with Interventional Neuroradiology can be made by calling the University Radiology East Brunswick Office (732) 390-0030.

What is Interventional Neuroradiology?

Interventional neuroradiology includes a wide range of minimally invasive treatments for medical conditions affecting the brain, spine, spinal cord, head and neck. Our interventional neuroradiologists use advanced medical imaging to look inside the body and treat complex health conditions without surgery. We provide treatment options for:

• Blood vessels in the brain, neck and spine including treatments for acute stroke, brain aneurysm, brain and spinal vascular malformations, nosebleeds and tumors.
• Bones and joints, including procedures to stabilize fractures in the spine.
• Combined Interventional Therapy with embolization, cryoablation and cement plasty for tumors.

Neurointerventional techniques are also used to diagnose problems with discs in the spine; to evaluate the spinal cord and nerve roots; and to take samples of spinal fluid to test for disease. At University Radiology, our board certified interventional neuroradiologists offer procedures including:

Interventional Stroke Treatment

The long-standing treatment for ischemic stroke, a blood clot in the brain, is to administer a clot-busting drug called tissue plasminogen activator, or tPA, as soon as possible after the onset of stroke symptoms. The medication is delivered through an intravenous (IV) line. However, IV therapy is not appropriate or effective for some patients. For those patients, our interventional neuroradiologists are treating acute stroke using interventional stroke treatment techniques.

Interventional stroke treatment uses X-ray imaging to precisely guide a small, flexible tube (catheter) to the exact site of a blood clot in the brain. The clot is then broken up with a mechanical device (Solitaire, Trevo, Ace devices) or clot-busting medication passed through the catheter.

What are the benefits?

• Disperses a clot and restores blood flow to the brain without the need for invasive surgery.
• An option for patients for whom IV therapy is likely to fail, including patients who have large blood vessel blockages.
• Interventional stroke treatment can remove a clot in a matter of minutes, while medication delivered via an IV line can take up to two hours.

How does the procedure work?

Using X-ray guidance, your interventional neuroradiologist will insert a catheter through the skin and into an artery or vein. He or she will then maneuver the catheter to the site of a blood clot in the brain. The clot is dissolved by medication passed through the catheter or physically broken apart by a mechanical device attached to the tip of the catheter. Your interventional neuroradiologist will monitor the procedure until X-rays show the blocked blood vessel has reopened.

Endovascular Brain Aneurysm Treatment

Endovascular brain aneurysm treatment is a minimally invasive procedure to treat a brain aneurysm, a bulge or a sac in an artery caused by the weakening of the arterial wall. If an aneurysm in the brain becomes too weak, it can rupture, resulting in a stroke or life-threatening bleeding in the brain. Coiling uses a small, soft metal coil - placed inside the aneurysm - to block the blood vessel and prevent it from leaking or rupturing.

What are the benefits?

• An effective treatment option for aneurysms that cannot be treated with surgery.
• Less invasive, which results in significantly less recovery time than open surgery.
• Can eliminate the symptoms of an aneurysm, including headaches and back and neck pain.

How does the procedure work?

Using X-ray guidance, your interventional neuroradiologist will insert a small, flexible tube (catheter) through the skin and into an artery or vein. He or she will then maneuver the catheter to the site of the aneurysm in the brain. Treatment options include coiling, brain stents (Neuroform stent, Enterprise stent) or the Pipeline endovascular device. One or more coils are passed through the catheter and inserted inside the aneurysm. The coils cause a blood clot to form inside the aneurysm, which permanently blocks off blood flow and eliminates the risk of rupture. Stents and Pipeline devices close the aneurysm by creating a "door" to the aneurysm or diverting flow away from the aneurysm.

Embolization of Brain Vascular Malformations

Embolization is a procedure to treat blood vessel malformations in the brain, neck and spine, including arteriovenous malformations (AVMs). AVMs are abnormal connections directly between arteries and veins. Malformations can cause headaches and other neurological symptoms as well as bleeding in the brain. Embolization uses medical glue, metal coils or other embolic agents to block blood flow to the malformation, effectively eliminating it and the symptoms it is causing.

What are the benefits?

• An effective treatment option for malformations that cannot be successfully removed via surgery.
• Less invasive, which results in significantly less recovery time than open surgery.
• Can eliminate the symptoms of a malformation, including hearing and vision problems.

How does the procedure work?

Using X-ray guidance, your interventional neuroradiologist will insert a small, flexible tube (catheter) through the skin and into an artery or vein. He or she will then maneuver the catheter to the location of the abnormal connection between an artery and vein. A liquid adhesive or other embolic (clogging) agent is injected to plug the malformation, permanently stopping blood flow. Most patients require a one-night hospital stay following the procedure.

Vertebroplasty and Kyphoplasty

Vertebroplasty and Kyphoplasty are treatments for pain caused by compression fractures in the spine - a common problem in patients with osteoporosis or spinal tumors. The nonsurgical procedure involves injecting a medical-grade cement into a fractured bone, sometimes inflating a balloon within the vertebral body. The procedure quickly improves back pain. It can also prevent further deterioration of vertebrae and put a stop to complications of osteoporosis such as height loss and curvature of the spine.

What are the benefits?

• Provides lasting pain relief within hours of the procedure.
• Many patients can resume normal activities right away.
• Stabilizes the vertebrae to prevent further damage to the spine.

How does the procedure work?

Your interventional neuroradiologist will insert a needle through the skin and into the fractured vertebra. The needle is precisely guided using fluoroscopy - real-time, moving X-ray images that your radiologist can view on a TV screen. Your doctor will then inject orthopedic cement into the vertebra and possibly use a balloon device to expand the space in the vertebra (kyphoplasty). The cement hardens within 15 minutes, stabilizing the fracture by essentially creating a cast within the vertebra. The procedure takes an hour or two, depending on the number of vertebrae being treated. Patients return home the same day.

Myelography

Myelography is a diagnostic imaging procedure to assess conditions affecting the spinal cord and spinal nerves. The procedure involves a special contrast material, or dye, injected into the spinal column and real-time, moving X-ray images (fluoroscopy). Your interventional neuroradiologist may use myelography to diagnose disc abnormalities, such as herniated discs, identify tumors or pinpoint nerve conditions.

What are the benefits?

• Can help determine the cause of nerve-related pain, numbness or weakness.
• An option for patients who cannot undergo MRI to assess disc problems.
• Allows your interventional neuroradiologist to view areas of the spine that are not clearly seen on standard X-rays.

How does the procedure work?

Under X-ray guidance, your interventional neuroradiologist will inject dye into the spinal canal. The dye allows your radiologist to more clearly see the spinal cord, nerves and other nearby structures. X-rays images are then taken of the area of the spine being studied to document any abnormalities. Myelography may be done in combination with other imaging procedures, such as a CT scan, to get a clear picture of the spinal anatomy.

Discography

Discography is a diagnostic imaging procedure to evaluate intervertebral discs - the spongy cartilage that provides cushioning between the bones (vertebrae) in the spine. The procedure can help determine the cause of back pain and provide your doctor with the information he or she needs to treat it.

What are the benefits?

• A painless, noninvasive and accurate way to evaluate discs.
• Helps identify discs that need to be treated or removed.
• Bone, soft tissue and blood vessels can all be imaged at the same time.

How does the procedure work?

Using X-ray guidance, your interventional neuroradiologist will inject a contrast liquid (dye) into one or more discs being evaluated. The contrast material provides sharper images during fluoroscopy. Fluoroscopy uses X-rays to create real-time, moving images of a disc that your radiologist can view on a TV screen. An X-ray or a CT scan may also be performed to capture pictures of the injected disc. Discography is performed under mild sedation so the patient can explain any pain or other symptoms during the test. The procedure is completed in less than an hour and patients go home the same day.

Lumbar Puncture

A lumbar puncture, also known as a spinal tap, is a minimally invasive procedure to diagnose diseases of the nervous system. A thin needle is inserted in the lower part of the spinal column to collect a small amount of spinal fluid. The fluid is then tested to detect bleeding, to diagnose infections such as meningitis or to help identify other neurological conditions such as multiple sclerosis and Alzheimer's disease.

What are the benefits?

• The most accurate way to identify whether symptoms such as a sudden, severe headache or neck pain are caused by a dangerous infectious disease.
• Fluid samples collected can help diagnose disorders such as Alzheimer's disease and other changes in the brain.

How does the procedure work?

Your interventional neuroradiologist will have you lie still on your side or abdomen. After injecting a local numbing medication, he or she will insert a needle into the spinal column using precise, X-ray imaging guidance. The needle is used to collect cerebrospinal fluid, which cushions the brain and spine from injury. The fluid is then sent for testing following the procedure, which lasts 20 to 30 minutes.

For an appointment: Call 800-758-5545 Mon - Fri: 8 am - 8 pm, Sat: 8 am - 12 pm

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