Advancements in Neurovascular Surgery Vivek R. Deshmukh, MD, FACS Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine Institute Neurovascular Surgery  Cerebral Aneurysm  Vascular Malformations of the Brain and Spinal Cord  Stroke Care  Carotid and Vertebral Atheromatous Disease  Vascular compression syndromes Neurovascular Service  Neurosurgery  Interventional Radiology  Stroke Neurology  Neurocritical care  Diagnostic Radiology  Rehab medicine  Radiation oncology Neurovascular  Surgical and Endovascular Treatments are complementary Intracranial aneurysms  1-5% of the population  Weakening of the blood vessel wall resulting in outpouching  Risk of rupture  Size- <5 mm less than 1% per year  Location- Basilar tip, acom artery, pcom artery  Patient specific factors- tobacco use, hypertension Treatment options  Clip ligation  Coil embolization  Stent coiling  Pipeline embolization  Cerebral bypass Stent-Coil animation Pipeline animation 53 year old female