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Interventional Neuroradiology

Supervisor: Dr. Timo Krings

The Toronto Western Hospital (TWH) training program in Interventional Neuroradiology (INR) of the University of Toronto was established in 1984 by Karel terBrugge under the supervision of Pierre Lasjaunias of France. Since then, more than 30 fellows from all over the world have been trained with us, many of whom now lead their own programs. We have trained fellows with neurosurgical, radiological, and neurological background.

The TWH INR Program will allow the applicants to become proficient in all aspects of Interventional Neuroradiology including the entire spectrum of vascular disorders of the central nervous system and percutaneous minimally invasive spinal procedures.

The TWH is a quarternary referral centre for brain and spinal AVMs, dural AV fistulae and vascular malformations of the head and neck region from all over North America http://brainavm.com/. We manage patients with epistaxis, complex intracranial and head and neck spinal tumours for preoperative embolization, and have the capability of intraoperative angiography. The Toronto Western Hospital has 1 of 3 primary stroke centres in the Greater Toronto area, therefore acute stroke treatment but also stroke prevention techniques (both extracranial and intracranial angioplasty and stenting) are routinely performed. Managements of intracranial aneurysms, including coiling, stent or balloon assisted, flow diversion or deconstructive techniques are a major focus of our workload. Minimally invasive percutaneous treatments such as spinal biopsy, vertebroplasty, kyphoplasty, nerve and facet blocks are also performed. Our program includes exposure to paediatric interventional procedures at the Hospital for Sick Children in Toronto where we manage Vein of Galen Malformation, paediatric AVFs and AVMs as well as paediatric aneurysms.

The multidisciplinary team at the TWH includes stroke neurologists and vascular neurosurgeons as well as stereotactic neurosurgeons, and, in association with the Hospital for Sick Children, paediatric neurosurgeons and paediatric neurologists and intensivists. A weekly multidisciplinary AVM and aneurysms outpatients clinic is held where we see between 30-50 patients each week, including new referrals and follow-up visits. At the TWH, we have weekly “Stroke” rounds, Neuroscience rounds (together with Neurology and Neurosurgery), INR-specific teaching rounds, and dedicated neurovascular rounds. In addition, monthly M & M rounds, Neuropaediatric vascular rounds, research rounds, and multidisciplinary AVM rounds with Neurosurgery and Radiosurgery are held. These rounds allow the trainees to gain experience on non-invasive vascular imaging. Since 1990, the TWH organizes an annual international Symposium on Interventional Neuroradiology http://sites.cepdtoronto.ca/inr/ in September attended by more than 200 participants yearly.

Two clinical fellowship positions are available with the workload being over 300 diagnostic cerebral and 30 spinal angiographic and 30 angiographies for Gamma Knife planning (that is performed in collaboration with Radiosurgery) per year. Annually, we perform more than 400 interventional procedures, among which 50 interventional procedures that are performed yearly at HSC. This also includes about 100 percutaneous spinal procedures that are performed each year. Since 1990, we have entered our patient collective into a prospectively maintained neurovascular database that by now encompasses more than 3000 AVMs.

The TWH has 2 state-of-the-art flat-panel biplane neuroangiographic suites, one of which is physically connected to a 3T MRI facility allowing for easy transfer between MRI and DSA, which may be required during management of patients with certain neurovascular disorders. One of the biplane angiography suites is also OR compatible allowing for combined surgical and endovascular procedures to be performed. In addition, we have 1.5T and two 3T MRIs on site with the capability of state of the art vascular imaging (including vessel wall imaging and dynamic MRAs) and two 64 slice CTs as well as one 320 slice CT (with the possibility of subsecond dynamic CTA). A 7T MRI system will be opened in 2013. Our INR team is composed of Drs. Karel terBrugge, Robert Willinsky, Richard Farb, Ronit Agid, and Timo Krings, and for spinal percutaneous procedures, Drs. Kieren Murphy and Roger Smith. http://brainavm.com/ Our team has fostered an INR Fellowship Program, which is internationally acclaimed for its academic commitment and scientific output with more than 100 peer-reviewed original articles in the period of the last 2 years (2010-2011).

http://www.ncbi.nlm.nih.gov/pubmed?term=terbrugge

In addition to one-year INR fellowships, we offer two years combined diagnostic and interventional Neuroradiological Fellowships as well as combined open neurosurgical/endovascular fellowships in collaboration with the Division of Neurosurgery. A two-year INR fellowship either at the TWH or combined with one year at St. Michael’s Hospital (see below) is available. To apply for the Interventional Neuroradiology Fellowhsip, please click link below.

Interventional Neuroradiology Fellowship

  • Interventional Neuroradiology Fellowship (TWH)
  • Interventional Neuroradiology Fellowship (St. Michaels Hospital)