Abstract
Background
Interventional neurology has achieved remarkable success in acute ischemic stroke management, aneurysm treatment, and arteriovenous malformation therapy through endovascular techniques that exemplify procedural precision and optimal clinical outcomes. Despite these advances, clinical scenarios persist where vascular access remains anatomically or physiologically limiting, creating therapeutic gaps in neurointervention. The spinal subarachnoid space, traditionally utilized only for diagnostic sampling or pharmacological delivery, represents an unexploited interventional pathway with unique therapeutic potential.
Objective
To establish endothecal intervention as a formal procedural category within interventional neurology, demonstrate clinical feasibility through extrasaccular aneurysm reinforcement, and position this methodology as the foundation for a comprehensive research program addressing consciousness disorders, chronic pain mechanisms, and neurogenic dysfunction with the ultimate clinical objective of treating coma.
Methods
Endothecal intervention employs intentional catheterization of the spinal subarachnoid space, primarily via lumbar access with planned expansion to cisternal approaches. This technique adapts proven neurovascular instrumentation to navigate the cerebrospinal fluid environment. Unlike vascular compartments, the CSF provides a low‐resistance, non‐circulatory environment enabling novel therapeutic delivery mechanisms.
The methodology integrates principles from oceanographic acoustics, particularly infrasound propagation models, with electrotactic navigation and liquid metal neurosensor applications. Guidance systems combine electrophysiological sensing, including impedance mapping, local field potentials visualization, to enable radiation‐free navigation through dynamic signal feedback and microstructural localization within the subarachnoid corridor.
Clinical Application
Extrasaccular Aneurysm Reinforcement Biocompatible materials deployed via subarachnoid navigation provide external structural support to aneurysm domes, serving independently or as adjunctive therapy to conventional endovascular techniques. This approach specifically addresses surgically and endovascularly inaccessible unruptured intracranial aneurysms, high‐risk dome morphologies, recurrent lesions following coiling or flow diversion, and giant or wide‐neck aneurysms with challenging geometries. Clinical advantages include elimination of intraluminal manipulation, absence of anticoagulation requirements, no postprocedural dual antiplatelet therapy protocols, and maintenance of population‐level safety profiles. The technique offers particular value where traditional endovascular approaches carry prohibitive risk or demonstrate limited long‐term durability.
Results
This initial application represents one neurointerventional component within a vast concept investigating endothecal approaches as well to chronical pain, hydrocephalus, neurogenic lower urinary tract dysfunction DoC,. The methodology draws upon emerging understanding of auditory preservation in coma, paradoxical zolpidem arousal mechanisms, and sleep‐state desynchronization patterns to develop targeted interventions for DoC. Additional applications under investigation include acoustic signal propagation for neural stimulation and electromechanical interface development for direct neuromodulation.
Conclusion
Endothecal intervention establishes the first formal framework for therapeutic subarachnoid space utilization, extending neurointerventions beyond vasculature, into CSF‐mediated therapeutics. This paradigm transforms the spinal canal from as it is until now, a passive diagnostic conduit, into active interventional platform, enabling novel therapies where conventional access routes prove inadequate and creating entirely new treatment modalities for previously intractable neurological conditions.
The methodology addresses clinical needs through aneurysm management while primarily was designed to measure and depict consciousness, aiming at understanding DoC and treatment of coma. Presenting this conceptual framework initiates essential cross‐disciplinary collaboration for preclinical validation, clinical translation, and the development of a new interventional subspecialty that extends therapeutic reach into previously inaccessible neurological domains.
Disclosure
No public access funding to disclose.
