Abstract 522: Endothecal Procedures: Repurposing the Spinal Canal for Interventional Neurology

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.