Endovascular neurosurgery
Dr. Merali completed fellowship training in endovascular neurosurgery and is Physician Lead for Neurointerventional Radiology at Trillium Health Partners. Endovascular procedures treat blood vessel problems from inside the vessel. A thin catheter is guided from an artery in the wrist or groin, so most procedures need no open surgery.
We provide consultation, treatment and long-term follow-up for patients with cerebrovascular conditions.
Conditions and treatment options
Brain aneurysm
A weak, bulging area of a brain artery. Many are found incidentally, and small aneurysms are often safely monitored. Options: surveillance imaging, coiling (with balloon or stent assistance) or flow diversion.
Carotid stenosis
Narrowing of the carotid artery in the neck, which raises the risk of stroke. Options: medical therapy for most patients, with carotid stenting for selected patients.
Arteriovenous malformation (AVM)
An abnormal tangle of arteries and veins in the brain that can bleed or cause seizures. Options: observation, embolization, surgery or radiosurgery, often in combination.
Dural arteriovenous fistula
An abnormal connection between arteries and veins in the covering of the brain, a known cause of pulsatile tinnitus. Options: embolization, sometimes combined with surgery.
Acute ischemic stroke
A blocked artery supplying the brain. When a large artery is blocked, the clot can be removed by thrombectomy. This is an emergency treatment accessed through 911, not by clinic referral.
Intracranial hemorrhage
Bleeding in or around the brain. We assess for an underlying vascular cause and provide follow-up.
Pulsatile tinnitus and IIH
Pulsatile tinnitus is a rhythmic whooshing sound in the ear that keeps time with the heartbeat. Unlike ordinary tinnitus, it can have an identifiable vascular cause. The most common treatable causes are a narrowing of a large vein draining the brain (venous sinus stenosis) and a dural arteriovenous fistula. When a narrowing is the cause, venous sinus stenting can relieve the sound in selected patients.
We are one of the few centres offering this treatment and can assess whether a patient is a candidate. Many patients and clinicians are not aware that this option exists.
Idiopathic intracranial hypertension (IIH) is raised pressure in the fluid around the brain without another identifiable cause. It typically causes headaches and can threaten vision. In selected patients with venous sinus stenosis, stenting can lower the pressure.
Referral requirements
Brain aneurysm
Pulsatile tinnitus
Brain AVM or fistula
A brief referral faxed to 1 (905) 228-4111 is enough. Our office will call the patient to book.
Sudden facial droop, arm weakness, trouble speaking or a sudden severe headache are emergencies. Call 911. Acute stroke is treated through the emergency system, not by clinic referral.