For years cardiologists have threaded hair-like surgical instruments through arteries in the wrist, as an access point to perform procedures on the heart.

For procedures in the brain, however, neurosurgeons more commonly thread instruments through arteries at the groin – a transfemoral approach.

In the largest cohort study to date, researchers have found that surgery via the wrist – known as transradial – is safe and effective for a broad range of neuroendovascular procedures, and gives patients faster recovery with less procedural risk.

The study was conducted in the US by the university, Jefferson. Neurological surgery professor and senior author Pascal Jabbour says: “Despite improved safety shown in large cardiology trials, transradial brain surgeries via the wrist are much less common. Neurosurgeons tend to prefer the transfemoral approach on which many of us were trained. But our research demonstrates that all kinds of neurological procedures can be done effectively and even more safely via the wrist.”

The study retrospectively examined the medical records of 223 patients treated at Jefferson via the transradial route.

A subset of 66 patients who had undergone both transfemoral (groin) and a transradial (wrist) surgeries were selected to complete a satisfaction survey to assess their preference. The majority of patients, 94 per cent, said they preferred surgery via the wrist.

In addition, it is easier to ensure a blood vessel in the wrist has clotted, and so patients can go home shortly after surgery, rather than laying horizontally for four to six hours after transfemoral surgery.

“Laying flat after certain kinds of brain surgery should be avoided in cases with high intracranial pressure, and yet it’s the best way to prevent groin and internal bleeds,” says Jabbour. “For these cases surgery via the wrist is by far the safest option.”

One of the most compelling reasons to change practice, says Jabbour, is that it eliminates the risk of rare but potentially dangerous complications of post-surgical bleeds in the groin and retroperitoneal area, which can be difficult to detect.

Jabbour was one of the first neurosurgeons to perform brain surgery via the wrist and has continued to teach others this technique.