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Cerebrovascular Disorders

The blood vessels of the brain and spinal cord are vital to life, supplying oxygen and nutrients to delicate neural tissue. Disorders affecting these vessels can be sudden, devastating, and life-threatening if not treated promptly.

Cerebrovascular neurosurgery addresses these problems directly, while endovascular neurosurgery provides a minimally invasive alternative by navigating through the blood vessels from within.

A/Prof Peter Mews is one of an extremely small handful of neurosurgeons in Australia dual-trained in both open vascular surgery and endovascular neurosurgery. This rare combination of expertise allows him to select the safest and most effective approach for each patient—whether that be traditional microsurgery, catheter-based endovascular treatment, or a hybrid of both.

By offering this unique skillset across Canberra, Wagga Wagga and the South Coast, A/Prof Mews ensures patients in regional areas have access to world-class cerebrovascular care without needing to travel interstate.

Conditions Treated

Brain aneurysms are weak spots in blood vessel walls that balloon outward. They may remain silent or rupture, causing a subarachnoid haemorrhage, a medical emergency with high risk of disability or death. In Australia, subarachnoid haemorrhage accounts for about 5% of all strokes, with more than 600 cases annually.

Causes:

  • Genetic predisposition
  • High blood pressure
  • Smoking
  • Certain connective tissue disorders

 

Symptoms (if unruptured):

  • Often none, but may cause headache, vision changes, or cranial nerve palsy

 

Treatment options:

  • Endovascular coiling (placing platinum coils inside the aneurysm to prevent rupture)
  • Flow diverters or stent-assisted techniques for complex aneurysms
  • Microsurgical clipping (placing a titanium clip across the aneurysm neck)

 

With dual training, A/Prof Mews is uniquely positioned to provide both coiling and clipping, tailoring treatment to the aneurysm’s size, shape, and location.

An AVM is an abnormal tangle of blood vessels that disrupts normal blood flow between arteries and veins. AVMs may present with headaches, seizures, or bleeding.

Causes:

  • Usually congenital (present from birth)

 

Symptoms:

  • Seizures
  • Headaches
  • Intracranial haemorrhage

 

Treatment options:

  • Endovascular embolisation (injecting a substance to block abnormal vessels)
  • Microsurgical removal
  • Radiosurgery (focused radiation for small AVMs)
  • Combined approaches depending on AVM size and location

Cavernomas are clusters of abnormally dilated blood vessels resembling mulberries. They may leak blood slowly or cause seizures.

Symptoms:

  • Seizures
  • Headaches
  • Neurological deficits from small bleeds

 

Treatment options:

  • Observation (if small and asymptomatic)
  • Microsurgical resection for symptomatic or high-risk cavernomas

Spontaneous bleeding into the brain tissue is often caused by long-standing high blood pressure, vascular malformations, or anticoagulant medications. Intracerebral haemorrhage accounts for around 10–15% of strokes in Australia.

Symptoms:

  • Sudden weakness
  • Speech disturbance
  • Severe headache
  • Loss of consciousness

 

Treatment options:

  • Emergency surgical evacuation of the haematoma
  • Decompressive craniectomy to relieve pressure
  • Medical management for stabilisation

Moyamoya is a rare progressive condition where major arteries at the base of the brain become narrowed, leading to the growth of fragile collateral vessels. These can cause recurrent strokes or haemorrhage, often in younger patients.

Symptoms:

  • Stroke or transient ischaemic attacks (TIAs)
  • Seizures
  • Cognitive decline

 

Treatment options:

  • Revascularisation surgery (direct or indirect bypass to restore blood flow)

Narrowing of the carotid arteries in the neck increases the risk of stroke. While often managed medically, severe cases may require surgical intervention.

Causes:

  • Atherosclerosis (plaque build-up)

 

Symptoms:

  • May be silent until stroke or TIA occurs

 

Treatment options:

  • Carotid endarterectomy (surgical removal of plaque)
  • Endovascular stenting for selected patients

In severe strokes, swelling of the brain can become life-threatening. Surgery may be required to relieve pressure.

Treatment options:

  • Decompressive craniectomy (removing part of the skull to allow swelling to expand safely)

Why Choose A/Prof Peter Mews?

Vascular neurosurgery is among the most technically demanding fields in medicine. Most neurosurgeons specialise in either open vascular surgery or endovascular techniques – but very few are formally trained and experienced in both.

This dual expertise allows A/Prof Peter Mews to:

  • Provide unbiased recommendations between clipping and coiling
  • Offer hybrid solutions when necessary
  • Tailor treatment to each patient’s anatomy and condition rather than being limited by technique

For patients, this means safer care, more treatment options, and the reassurance of being in expert hands.

By combining cutting-edge training with compassionate, patient-centred care, A/Prof Mews delivers advanced cerebrovascular surgery to communities across Canberra, Wagga Wagga and Moruya (South Coast).

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