Anaesthesia for interventional neuroradiology

Anaesthesia is required for neuroradiological diagnostic procedures such as angiograms, computerized tomography (CT), and magnetic resonance imaging (MRI) or for therapeutic intervention (Table 1). Interventional neurovascular procedures are part of a trend towards minimally invasive neurosurgery, an important development in which has been the introduction of the Guglielmi detachable coil (GDC) for endovascular aneurysm coiling. Evidence that coiling is associated with a better outcome than craniotomy and clipping is moving more procedures out of theatres into the neuroradiology suite. Prolonged procedures, improved patient safety, and optimal conditions for imaging have resulted in a trend towards a greater use of general anaesthesia (GA), especially in aneurysm and arteriovenous malformation (AVM) treatments, while conscious sedation is preferred for cerebral ischaemic disease (carotid stents, angioplasty, and thrombolysis). Though many of the risks encountered in this newer arena are conceptually similar to traditional neurosurgery, important differences in the working environment and practice exist.