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Interventional Neuroradiology Fellowship (TWH)

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 50 fellows from all over the world have been trained with us, many of whom now lead their own programs. We have trained fellows with backgrounds in neurosurgery, neurology and radiology.

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 referral center for complex aneurysms, brain and spinal AVMs, dural AV fistulae and vascular malformations of the head and neck region from all over North America. We manage patients with epistaxis, complex intracranial, head and neck and spinal tumors with preoperative embolization, and have the capability of intraoperative angiography as well as a combined angio /MRI suite. The Toronto Western Hospital is a primary acute stroke center with more than 100 acute stroke treatments each year. Stroke prevention procedures (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 routinely performed. Our program includes exposure to pediatric interventional procedures at the Hospital for Sick Children in Toronto where we manage Vein of Galen Malformation, pediatric AVFs and AVMs as well as pediatric aneurysms and stroke.

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, pediatric vascular neurosurgeons and neurologists. A weekly multidisciplinary AVM and aneurysms outpatient 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, Neuropediatric 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 and multidisciplinary management of complex vascular malformations. Since 1990, the TWH organizes an annual international Symposium on Interventional Neuroradiology in September attended by more than 200 participants yearly.

Three clinical fellowship positions are available with the diagnostic workload being over 300 diagnostic cerebral and 30 spinal angiographic procedures and 30 angiographies for Gamma Knife planning (that is performed in collaboration with Radiosurgery) per year. Annually, we perform more than 500 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 5000 aneurysms and 3000 AVMs of various types..

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 two 1.5T and one 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). An additional 3T MRI and a 7T MRI system will be opened in 2019.

Our INR team is composed of Drs. Timo Krings, Vitor Pereira, Ronit Agid and Richard Farb and for spinal percutaneous procedures, Drs. Kieran Murphy and Roger Smith.

Our team has fostered an INR Fellowship Program, which is internationally acclaimed for its academic commitment and scientific output, please click here for our recent publications.  

In addition to one and 2 year INR fellowships, we offer a two year 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 Fellowship, please click link below.

If you have any additional questions regarding the fellowship, please contact Dr. Timo Krings.

The TWH INR Fellowship Program is held in accordance with the UEMS recommendations for acquiring particular qualifications in endovascular interventional Neuroradiology and WFITN guidelines for training in Interventional Neuroradiology