Published online: 18 May 2002 © Springer-Verlag 2002 Categorical Course ECR 2003 Abstract This article summarizes recent developments in the growing field of interventional neuroradiolo- gy for the treatment of acute cere- brovascular disease. We describe the possibilities in endovascular therapy of acute cerebral aneurysms using electrolytically detachable coils combined with trispan neck bridging devices and stent implantation to oc- clude acute wide neck aneurysms. Techniques and results of local intra- arterial thrombolytic therapy in acute stroke and central retinal artery oc- clusion are described and we discuss the potential for rapid, large-burden thrombus removal in cases of inter- nal carotid artery thrombosis by rheolytic thrombectomy, percutane- ous transluminal angioplasty and stent implantation. Emergency endo- vascular therapy using the transve- nous approach to treat severe intra- cranial or intraocular hypertension and multifocal haemorrhagic venous infarction due to cerebral sinus thrombosis or dural fistulas is also described. In cases of acute bleeding of head and neck lesions following trauma, tumours after radiotherapy, arteriovenous malformations, epi- staxis or from iatrogenic origin, angiography plays a major role in localizing the source of bleeding and occluding the damaged vessel during the same session using the same en- dovascular approach. Keywords Interventional neuroradiology · Endovascular treatment · Interdisciplinary therapy · Head and neck · Aneurysm · Stroke Eur Radiol (2002) 12:1648–1662 DOI 10.1007/s00330-002-1504-1 EMERGENCY RADIOLOGY Gerhard Schroth Karl-Olof Lövblad Christoph Ozdoba Luca Remonda Non-traumatic neurological emergencies: emergency neuroradiological interventions Introduction The dynamic evolution of imaging and minimally inva- sive techniques, as well as the increase of knowledge in the field of neuroscience and clinical experience ob- tained by close cooperation between neurologists, neuro- surgeons, craniofacial-, head and neck surgeons and neu- roradiologists, has opened new possibilities to treat life- threatening diseases of the central nervous system and head and neck using endovascular, minimally invasive approaches [1, 2, 3]. Normally, therapeutic procedures in the head and neck in emergency situations are best performed under general anaesthesia [4, 5], except when patient coopera- tion is required, e.g. if occlusion of the carotid or verte- bral artery has to be performed. General anaesthesia guarantees optimal working conditions for the intervent- ional neuroradiologist such as high-quality (1024×1024 matrix) digital subtraction angiography (DSA) images, stable biplane road maps or 3D projections, and mini- mizes the risk of vascular spasms due to catheter manip- ulation. Neuroleptic analgesia or light sedation based on benzodiazepines, such as diazepam or midazolam and opioids, is considered the alternative method of choice for cooperative patients in our institution. The following examples discuss the role and recent advances of interventional neuroradiology in the inter- disciplinary management of acute, life-threatening situ- ations among neurosurgeons, neuroanaesthesiologists, head and neck surgeons and other neuroscientists. G. Schroth ( ✉ ) · K.-O. Lövblad C. Ozdoba · L. Remonda Department of Neuroradiology, University of Bern, Inselspital, Friburgstrasse 10, 3010 Bern, Switzerland e-mail: Gerhard.Schroth@insel.ch Tel.: +41-31-6322654 Fax: +41-31-6324872