Minimally Invasive Cerebrovascular Care
Endovascular Neurosurgery on Long Island
Endovascular neurosurgery is a minimally invasive specialty that treats diseases of the brain’s and spinal cord’s blood vessels — aneurysms, arteriovenous malformations (AVMs), acute ischemic stroke, and other cerebrovascular conditions — from inside the blood vessels themselves.
Board-certified neurosurgeon Dr. Symeon Missios, MD, FAANS, performs endovascular procedures as part of a comprehensive cerebrovascular practice on Long Island, giving patients access to the most appropriate treatment — open, endovascular, or combined — for their specific condition.
What Is Endovascular Neurosurgery?
Endovascular neurosurgery (sometimes called neurointerventional surgery) uses real-time X-ray imaging — angiography — to guide tiny tools through the blood vessels to the brain.Catheters, microcatheters, microwires, coils, stents, and liquid embolic agents allow the surgeon to repair aneurysms, close off abnormal connections, dissolve or extract clots, and treat narrowed vessels — all without an open craniotomy.Because the same neurosurgeon can be trained in both open cerebrovascular surgery and endovascular techniques, treatment decisions can be made from a complete perspective.
Precision Guidance
Conditions Treated
Procedures We Perform
Benefits of Endovascular Treatment
What to Expect: The Care Journey
Before
Pre-procedure planning includes detailed imaging (CTA, MRA, or diagnostic angiography), medical optimization, and a thorough discussion of risks and benefits.
During
Performed under general anesthesia in a neuro-angiography suite. A small puncture is made in the wrist or groin. Catheters are navigated to the target vessel under continuous X-ray guidance.
After
Observed in a neuro ICU or step-down unit overnight. Many elective patients go home within 1-2 days. Return to normal activity is typically within one to two weeks.
The Spine Surgery Process
Consultation
Dr. Missios reviews your imaging, medical history, and prior treatments, and discusses whether endovascular surgery is the best fit. For cancer-related cases, the recommendation is made in coordination with your oncology team.
Planning Day
A custom immobilization device (typically a facemask) is fabricated. High-resolution MRI and CT scans are obtained and fused. The neurosurgery, radiation oncology, and medical physics team designs a custom treatment plan with multiple beam angles to focus the dose precisely on your target.
Treatment Day
Treatment is painless — most patients describe it as similar to having an MRI. Depending on the target and the technology used, a single session typically lasts 30 to 90 minutes. Most patients drive themselves home the same day.
Follow-Up
Follow-up MRI scans, generally at three-month intervals initially, are used to confirm tumor control. SRS does not typically shrink tumors immediately — the goal is to stop growth and often produce gradual shrinkage over months to years.
Endovascular vs. Open Cerebrovascular Surgery
Both approaches are essential tools. Endovascular treatment generally offers a less invasive option with faster recovery and is the standard of care for many aneurysms, acute large-vessel strokes, and dural fistulas.
Open microsurgical clipping remains the better choice for certain aneurysms — those with wide necks, complex branch anatomy, or large size — and for AVMs and hematomas where direct removal is needed.
Because Dr. Missios’s practice spans both worlds, treatment decisions are based on what is best for the patient, not on what a single technique can offer.
Why Patients Choose Dr. Missios
Frequently Asked Questions
Endovascular treatment is less invasive and generally has a shorter recovery, but every procedure has its own risk profile. For some aneurysms and conditions, endovascular treatment offers the best risk-benefit ratio; for others, open surgery does. The right choice is patient-specific and discussed in detail at consultation.
Many elective endovascular procedures involve a one- to two-day hospital stay, with return to light activity within a week and to most normal activities within two to three weeks. Recovery from stroke thrombectomy depends on the stroke itself rather than the procedure.
Not always. The decision depends on aneurysm size, shape, neck width, location, and the involvement of nearby branches. Some aneurysms are better suited to open clipping, and some can be safely observed with serial imaging. We evaluate each case individually.
Mechanical thrombectomy is the physical removal of a large-vessel clot in acute ischemic stroke using a catheter-based device. Eligibility depends on imaging findings and the time since symptom onset; many patients can be treated up to 24 hours after stroke onset when imaging shows salvageable brain tissue. Faster is always better — every minute matters.
Most cerebral endovascular procedures are performed under general anesthesia for patient comfort and precision. Some diagnostic angiograms are performed with light sedation. Your anesthesia plan is discussed before the procedure.
Schedule a Cerebrovascular Consultation on Long Island
If you or a loved one has been diagnosed with an aneurysm, AVM, stroke, or another cerebrovascular condition, you deserve a clear, unhurried conversation with a board-certified neurosurgeon trained in both open and endovascular treatment. Dr. Missios sees patients at three convenient Long Island locations and offers second-opinion consultations.