Vascular neurosurgery deals with problems of the blood vessels of the brain and spinal cord, such as aneurysms, brain haemorrhage, arteriovenous malformations (AVMs) and cavernomas. Some of these are found by chance on a scan and need careful planning; others cause sudden bleeding and need emergency treatment.
For families in Lahore facing one of these diagnoses, this page explains the main conditions, how neurosurgeons and interventional (endovascular) specialists work together, and when to seek urgent help.
Bleeding in or around the brain is a medical emergency. Call an ambulance or go to the nearest emergency department straight away if someone has:
Do not wait to see whether the headache settles, and do not give aspirin. Early CT scanning in hospital is essential.
An aneurysm is a weak, ballooned area in an artery wall. Many are small and never rupture; a ruptured aneurysm causes subarachnoid haemorrhage and needs urgent treatment. Options include observation, surgical clipping and endovascular coiling. Read more about brain aneurysm treatment.
Bleeding inside the brain or between its coverings, from high blood pressure, head injury, an aneurysm or abnormal vessels. Treatment ranges from careful medical management to burr hole drainage or craniotomy. See brain haemorrhage treatment.
An AVM is a tangle of abnormal arteries and veins without the normal small vessels in between. AVMs may cause bleeding, seizures or headaches. Treatment may involve surgical removal, embolisation (blocking vessels from inside), focused radiosurgery, or observation for some unruptured AVMs, depending on size, location and the patient's age.
Cavernomas (cavernous malformations) are small berry-like clusters of abnormal vessels. Many cause no symptoms and are simply monitored. Surgery may be considered if a cavernoma bleeds repeatedly or causes seizures that are hard to control, and is accessible.
Many vascular conditions can be treated in two different ways:
Neither approach is best for everyone. The choice depends on the shape and location of the lesion, whether it has bled, the patient's age and health, and the expertise available. Ideally, decisions are made jointly, and patients may sometimes need both, for example embolisation before AVM surgery, or surgery to drain blood or fluid after an aneurysm has been coiled.
Outside emergencies, see a neurosurgeon if a scan has shown an unruptured aneurysm, an AVM or a cavernoma, if you have had a brain bleed and need follow-up planning, or if you have a strong family history of aneurysms and want advice about screening. Bring all CT, MRI and angiography images on CD as well as reports.
At consultation, Dr. Khawar Anwar reviews your imaging and history, including blood pressure, smoking and family history. He explains the natural history of your condition, meaning the estimated risk of leaving it alone compared with the risks of treatment. Where appropriate, the case is discussed with an interventional neuroradiologist so that you receive a balanced view of surgical and endovascular options.
Many unruptured vascular lesions do not need immediate treatment. Controlling blood pressure, stopping smoking and regular imaging may be the safest plan for some people. When treatment is advised, the least invasive effective option is chosen for that particular lesion, whether that is open surgery, endovascular treatment, radiosurgery or a combination. Bleeding emergencies are treated urgently with a focus on stabilising the patient first.
To discuss your scan, please book an appointment.
No. Many small aneurysms have a low risk of bleeding and are monitored. Treatment depends on size, shape, location, your age, and factors such as previous bleeding or family history.
Clipping is an open operation where a small metal clip is placed across the neck of the aneurysm. Coiling is done from inside the artery by an interventional neuroradiologist. The better option is decided case by case.
Some AVMs can be removed completely with surgery, embolisation or radiosurgery. Others are high risk to treat and are better observed. Your specialists will explain which applies to you.
No. Most cavernomas are monitored. Surgery is considered when there is repeated bleeding or difficult seizures and the cavernoma can be reached safely.
Yes. Long-standing uncontrolled blood pressure is one of the most common causes of bleeding inside the brain, which is why good blood pressure control is important.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.