Clinical Services


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  • Therapeutic services

    The UMMC Neurovascular (Stroke) Group offers a complete array of therapeutic services including advanced surgical techniques, Guglielmi detachable coils (GDC), circulatory arrest, stereotactic guidance, electrophysiologic monitoring, and access to the newest medications for neuronal and cerebral protection.

    The Stroke Group emphasizes an interdisciplinary approach to the management of stroke patients. Various specialties apply their expertise to determine the ideal approach for each patient. An interdisciplinary neurovascular conference is held regularly to help achieve our goal of providing the best treatment available for each patient. The Stroke Group provides the following therapeutic services:

    Endovascular techniques

    The Neurovascular (Stroke) Group has at its disposal several endovascular procedures for patients with AVMs or aneurysms. These minimally invasive procedures, which do not require an incision, are generally better tolerated than conventional surgery.

    • Endovascular treatment of aneurysms is currently the preferred modality for most patients harboring these lesions. GDC coils can be guided into an aneurysm via a catheter, creating a clot that effectively closes the aneurysm off from the surrounding circulation. Trapping or proximal balloon occlusion is another form of treatment used to block the artery leading to the aneurysm, thereby causing the aneurysm to thrombose.
    • Endovascular treatment of AVMs and fistulae - UMMC's neuro interventionalists are involved in the endovascular treatment of AVMs and fistulae as well. This involves the use of a type of "glue" or coils, introduced via a tiny catheter, to block off abnormal blood vessels. These procedures often reduce the size of the AVMs, allowing the use of stereotactic radiation and microsurgery. Furthermore, they can be curative for a variety of other vascular malformations.
    • Extracranial angioplasty and stenting - This minimally invasive way of treating narrowed blood vessels in the neck that are at risk for causing stroke is gradually gaining acceptance. Currently, we reserve these procedures for patients whose disease is not amenable to surgical treatment or those who strongly prefer a minimally invasive approach.
    • Cerebral angioplasty and intra-arterial thrombolysis are new therapeutic procedures. These techniques are also performed endovascularly and are similar to those current done on the heart. Silicone microballoon systems are now capable of dilating small intracranial arteries. Stents are being developed to maintain lumen diameter in the cerebral circulation, also.
    • Angioplasty treatment of vasospasm involves physically dilating a blood vessel affected by subarachnoid hemorrhage induced vasospasm. Transluminal angioplasty is frequently used in conjunction with intra-arterial papaverine to reverse vasospasm.

    Surgical techniques

     

    • Carotid endarterectomy is often performed under local anesthesia, which reduces the complications. The excellent surgical results of the Stroke Group, past and present, have been published in peer-reviewed journals.
    • Microsurgery is a treatment modality available at UMMC for the treatment of aneurysms and AVMs. The binocular magnification and excellent lighting provided by the operative microscope makes these delicate operations much safer. For deep-seated lesions, stereotactic techniques which rely on sophisticated computer technology and uses geometric principles to precisely localize the coordinates of the AVM are used. Using three-dimensional reference points, targets are established that enable the neurosurgeon to access the previously plotted area with a precision of a few millimeters without disrupting normal brain tissue. Interventional MRI is the next generation of stereotactic guidance. This technology will not only ensure precise localization, but also ensure complete removal of AVMs and cavernous malformations.
    • Hypothermia is a neuro-protective tactic that provides the surgeon with the necessary time to treat complex AVMs and aneurysms. Recently researchers have discovered that dropping brain temperature to just 32° C (mild hypothermia) still resulted in significant protection against intraoperative stroke. This knowledge is now routinely used for cerebrovascular surgery, in combination with circulatory arrest of the area surrounding the aneurysm or AVM.
    • Revascularization of the brain blood supply is a technique for treating an aneurysm or occluded cerebral artery that provides a bypass route for blood to the brain by grafting the saphenous vein or a scalp artery to a cerebral artery. After obliterating the aneurysm, or in the presence of an occluded artery, the graft is placed to revascularize the brain area. Moyamoya disease, an occlusive cerebral arterial vasculopathy that often affects children and young adults, and giant aneurysms can be addressed with these brain revascularization techniques.

    Stereotactic radiation techniques

    Stereotactic radiosurgery is a minimally invasive technology which shrinks away certain small, well circumscribed tumors and arteriovenous malformations within the brain. The technique is often used on deep seated AVMs that are not amenable to surgical treatment.

    • Gamma knife radiosurgery utilizes non-invasive photon beams to radiate an AVM with low risk to the surrounding normal brain. The procedure lasts approximately 30 minutes, and usually results in gradual narrowing of the blood vessel walls. Most AVMs become obliterated within two years of radiosurgery.