Vascular neurosurgery

We have treated more than 6000 aneurysms by surgery. We perform microsurgery treatment (including clipping and bypass) and endovascular treatment (blocking the aneurysms by coils or stents delivered from a tube inserted in the artery).

As there is great variation of complexities in aneurysms and surgical best practices, our multidisciplinary team approach ensures that the treatment recommended is personalised to each patient.

If an aneurysm is discovered after it has burst, leading to a bleed in or around the brain (subarachnoid haemorrhage), our well-developed protocols and integrated team approach ensure rapid care for seriously ill patients.

If surgery or endovascular treatment is not necessary, our surgeons will monitor aneurysm growth and provide recommendations on modifying risk factors to avoid rupture.

AVMs of the brain – a tangle of fragile arteries and veins resembling a small ball of string – are responsible for bleeding into the brain. Approximately 200 Australians are diagnosed with this condition each year.

The Macquarie Neurosurgery team has treated more brain AVMs than any other Australian group.

With three modes of treatment available, including microsurgery, radiosurgery (by Gamma Knife) and embolisation (blocking the vessels of the AVM by glue delivered from a tube inserted in the artery), the options for treatment are as comprehensive as anywhere in the world.

Our experts contribute significantly to the current dialogue and debate among the world’s leading neurosurgeons on the best way to manage brain AVMs. We are also involved in research that looks to new ways of preventing brain AVMs from bleeding.

Brain bypass surgery is sometimes necessary to treat conditions that reduce the blood flow to the brain (such as Moyamoya – see below).

It may also be necessary if blood vessels need to be replaced in the management of aneurysms or tumours of the skull base. Because of the varied indications for bypass surgery, there are different types of bypass that might need to be performed. These bypass types are divided into high-flow bypass techniques and augmentation bypass techniques.

Bypass surgery is rarely needed and performed. However, our experts have performed more than 400 bypass surgeries and have published their results in leading journals.

Moyamoya – which means ‘puff of smoke’ in Japanese – is a rare, progressive disease characterised by blocked arteries at the base of the brain.

In patients who have this condition, bypass surgery is generally indicated in order to provide additional blood flow to the brain.

Macquarie Neurosurgery’s neurosurgical team has a high level of skill and experience in the treatment of children and adults with Moyamoya disease. Members of the surgical team trained at Stanford University, which is considered the world’s foremost authority on this uncommon disease.

Our surgeons have looked after more than 50 patients with Moyamoya disease, making them some of the country’s leading specialists trained in this condition.

Some of our current research projects include:

• outcomes for bypass surgery in intracranial occlusive disease
• ongoing clinical projects – retrospective in many cases
• thrombotic occlusion of brain arteriovenous malformations (brain AVMs) using vascular targeting. Currently, the only effective way to treat these are through surgery or Gamma Knife, but not all patients can have these treatments. We are working on a process in which the Gamma Knife is used to change the characteristics of the vessels before treatment. Animal models have shown promising results and we are now investigating clinical trials.

Our fellowship position, where a fully trained neurosurgeon works with us for a year or two to develop specialty skills in vascular neurosurgery, is highly sought after around the world. In the last ten years we have welcomed fellows from the USA, Switzerland, Norway, Spain and India.

A key advantage of our training is that, because we perform so many surgeries, people who come to train with us will develop specialty skills and knowledge in the management of cases they would not see anywhere else.