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Scope of practice

Conditions treated

Vascular disease of the brain and spine, approached from inside the vessel through a catheter and from outside through open microsurgery. Each page below explains how the condition presents, how it is investigated, and what the treatment choices actually involve — including when the right answer is to leave it alone.

Brain aneurysm

A weak spot ballooning from an artery wall. Most are found by accident and never bleed. Deciding which ones need coiling, flow diversion or clipping — and which are safer watched — is the whole of the work.

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Arteriovenous malformation

A tangle where arteries feed straight into veins. It may bleed, cause seizures, or sit quietly for a lifetime. Treated by embolisation, surgery, radiosurgery, or a planned combination.

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Dural arteriovenous fistula

An abnormal artery-to-vein connection in the covering of the brain. Classically heard as a pulsing noise in one ear. Where it drains decides whether it is harmless or dangerous.

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Carotid-cavernous fistula

A leak between the carotid artery and the veins behind the eye. The eye becomes red, protruding and pulsatile — and is often treated as infection for weeks first.

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Chronic subdural haematoma

Old blood over the surface of the brain in an older adult, weeks after a forgotten fall. Frequently mistaken for dementia, and among the most reversible conditions in neurosurgery.

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Pulsatile tinnitus

A whooshing sound in time with the heartbeat. Unlike ordinary tinnitus this usually has a physical cause in a blood vessel, and some of those causes are worth finding.

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Cavernoma

A mulberry-like cluster of low-pressure vessels that leaks rather than bursts. Whether to remove one depends on where it sits and how it has behaved.

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Spinal vascular malformation

Slowly progressive leg weakness and bladder trouble, routinely attributed to a degenerating spine. Found late, the disability becomes permanent.

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Carotid & narrowed arteries

Carotid stenosis, intracranial narrowing, moyamoya disease and arterial dissection. Arteries that warn before they cause a stroke.

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Acute stroke

Mechanical thrombectomy for a blocked large artery, available round the clock. Everything here is decided by how fast the patient reaches treatment.

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Also treated

Beyond the conditions above

  • Subarachnoid haemorrhageSecuring the ruptured aneurysm, then managing vasospasm and hydrocephalus through the critical two weeks that follow.
  • Intracerebral haemorrhageAssessment for surgical or minimally invasive evacuation, and the search for an underlying vascular cause.
  • Cerebral venous sinus thrombosisAnticoagulation, and endovascular thrombectomy for patients who deteriorate despite it.
  • Idiopathic intracranial hypertensionVenous sinus stenting for selected patients with venous stenosis and failing vision.
  • Paediatric vascular diseaseAneurysms, malformations and vein of Galen lesions in children, treated surgically or endovascularly.
  • Pre-operative tumour embolisationReducing blood loss before removal of vascular tumours of the brain, skull base and spine.

Not sure whether this needs treating?

That is usually the right question, and often the answer is no. Send the scans and you will get a straight opinion — including when the safest course is to do nothing and watch.