The Department of Neurological Surgery has long been a patient-centered clinical service that provides a full breadth of services.
Stereotactic Radiosurgery (SRS)
The department has been an innovator in the area of Stereotactic Radiosurgery (SRS). SRS is a method of treating lesions in the brain and at the skull base, with a highly concentrated dose of x-rays, by aiming radiation beams only at the target and not the surrounding brain. A very powerful dose can be delivered while making a risk of complications minimal. Drs. Gandhi, Goldstein, Liu and Prestigiacomo use the latest radiosurgical planning system developed by Radionics Incorporated, known as X-Knife RT, in conjunction with two linear accelerators (LINAC). With this technology, the doctors are able to target the area of interest, as well as avoid radiation to critical parts of the brain. SRS is used to treat patients with a large variety of conditions, including gliomas, meningiomas, acoustic neuromas, other schwannomas, trigeminal neuralgia, and arterial venous malformations.
The Center for Image-Guided Surgery is dedicated to providing patients with the latest advances in neurosurgical technology. What these methods have in common are the incorporation of cutting edge imaging modalities, including intraoperative MRI, high-field strength MRI, and functional imaging into the treatment plan and surgical procedure itself. As part of our mission to advance the field of image-guided neurosurgery, we work in conjunction with other departments , other leading medical centers, and various high-tech companies on a number of projects.
We were the first institution in North America, and only the second in the world, to use the innovative Pole Star N-10 intraoperative MRI system. We have recently installed the latest generation of this device, the Pole Star N-20. The acquisition of continually updated images during surgery, coupled with intraoperative navigation, allow for maximum precision of tumor resection and minimal disturbance of normal areas of the brain.
Intraoperative MRI allows the surgeon to monitor the progress of a procedure, for instance, during tumor removal. The possibility of a surgical cure is increased because no surprises are left for an MRI scan done the day after surgery, as was done in the past. The potential dangers of brain shift, whereby, during surgery the brain can move and render inaccurate coordinates obtained from preoperative imaging, is overcome by the freshening of images obtained during surgery.
For image-guided surgery, we were the first to describe the method whereby critical brain areas (such as those responsible for movement, sensation, vision, and speech) can be mapped onto a computer in the operating room in a non-invasive way via intraoperative MRI. For example, using surgical navigation in the operating room, we can precisely define not just the location of a lesion, such as a tumor, but also areas of the brain that must be avoided during surgery. Our functional imaging laboratory also develops ways of mapping the surface of the brain along with the critical pathways, known as white matter, that connect the brain to other parts of the body. We also reported the first series of incorporation of functional MRI for stereotactic radiosurgery. Thus, we can utilize functional image guidance not just for open surgery, but also for non-invasive treatment of a variety of intracranial lesions.
Cerebrovascular & Endovascular Neurosurgery
The Cerebrovascular Center School is lead by Drs. Charles J. Prestigiacomo, Chirag D. Gandhi, and E. Jesus Duffis along with the assistance of Brigitte Ramones, APN. This multi-disciplinary service works in cooperation with Neuroradiology, the Section of Vascular Neurology and the Section of Vascular Surgery to efficiently evaluate and treat, both operatively and non-operatively, patients with diseases of the blood vessels supplying the brain and spinal cord including:
- Arteriovenous Malformations (AVM) Vascular Tumors
- Extracranial cerebral vascular disease
- Intercranial artherosclerosis
- Spinal Cord AVM/AVF
- Pre-operative embolization of brain and spinal tumors
This multi -disciplinary service offers both diagnostic and interventional capabilities for vascular pathologies of the brain and spinal cord. The center specializes in endovascular treatment of aneurysms, AVMs (both spinal and cranial), intracranial and extracranial atherosclerosis, as well as non-vascular procedures, such as vertebroplasty/ kyphoplasty. There is very close cooperation with the Neurology Stroke team to offer 24-hour interventional capability in support of our Comprehensive Stroke Center.
Cutting Edge Endovascular Technology and Humanitarian Use Devices
Humanitarian Use Device is used to diagnose or treat a disease or condition that affects fewer than 4,000 individuals in the United States per year and for which no comparable device is available. We are currently working with four HUD studies for treating aneurysms.
Some types of aneurysms are difficult to treat with coils alone, they can have such a wide opening that the coils might not be able to stay in and fall back into the blood vessels or block blood flow.The CODMAN ENTERPRISE™ Vascular Reconstruction Device and Delivery System and Neuroform EZ™ Stent System for Intracranial Aneurysms are HUD devices that both use a type of self-expanding intracranial stent made from a materiel called nitinol and are used to treat “wide neck” cerebral aneurysms. The stent is threaded through the artery to the aneurysm sac, coils are then released and used to fill the aneurysm, lowering the chances of the aneurysm rupturing. The stent is being used to help keep the coils from falling out of the aneurysm sac.
Onyx Liquid Embolic System (HD-500) is a liquid packing material injected through a micro catheter into the aneurysm. Once injected the material hardens filling up the aneurysm intending to excluded the aneurysm sac from intracranial blood pressure while preserving the parent artery circulation.
Wingspan™ Stent System with Gateway™ PTA Balloon Catheter is used to open up an artery with >50% blockage to prevent the thickening arterial walls from collapsing, to improve blood flow to your brain and prevent stroke.