Interventional Neuroradiology in Thailand: 1989–1997

Abstract

In 1979 the Siriraj team in Bangkok began exploring a field that was then new in Thailand, i. e. interventional neuroradiology. This first phase consisted mostly in self-training and foreign exposure. It included experimental work with animal models, as well as early clinical trials designed to assess our skills in particle embolisation and the ligated and detachable balloon techniques. In 1990 a new phase started. Essential techniques were acquired in collaboration with the neurovascular unit of Bicêtre Hospital in France during a three year training programme. Throughout this period, the support of the Association Médicale Franco-Asiatique (AMFA) and the French foreign affairs department proved vital. Our department progressively became a referral centre for the different techniques used in embolisation (balloons, glue…) and for various vascular lesions of the brain, the head and neck region, and spinal cord diseases. Within Mahidol University, the Ramathibodi and Prasat Hospital centres started the same interventional neuroradiology training program in 1995; they benefited from the same tutors and connections as Siriraj. In 1996, the newly acquired biplane DSA machines in both centres enabled us to improve the treatment of arteriovenous malformations - using the glue technique –, intracranial aneurysm - using GDC-coils -, clot lysis, angioplasty… etc. According to international recommendations, the critical mass we reached in 1997 in terms of number of patients and interventions, allows us to offer training in endovascular techniques to junior neuroradiologists at Mahidol university.