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 The UCSD - Neurovascular Surgery and Stroke Prevention Program

The Center provides the highest level of care for patients with aneurysms and arteriovenous malformations(AVMs) as well as other neurovascular problems of the brain and spinal cord such as carotid stenosis, Moya-moya disease and acute stroke. Our highly experienced staff includes physicians specializing in neurosurgery, neurology and interventional neuroradiology; nurses, therapists and social workers. Utilizing advanced neurologic technology, this multidisciplinary team works together to prevent or minimize the neurologic impact of an aneurysm or AVM and maximize the patient's recovery.

 

Our Multidisciplinary Team:

  • Neurosurgery:  Dr. Alexander Khalessi, Dr. Hoisang U , Dr. Bob Carter, Dr. Andrew Nguyen, Dr. David Levy, Dr. Sean Pakbaz
  • Neuroradiology:  Dr. John Hesselink and Director. Dr. Roland Lee
  • NeuroAnesthesia: Dr. Piyush Patel, Dr. John C. Drummond, M.D., Dr. Brian Lemkuil
  • Neurology: Dr. Brett Meyer, Dr. Tom Hemmen
  • Neurocritical Care: Dr. Navaz Karanjia, Brian Lemkuil, and Anushirvan Minokadeh, MD

 

To have your materials reviewed at our weekly multidisciplinary conference, please find instructions here.

 

ANEURYSM / AVM CONFERENCE

Each Week, Center staff members convene at an Aneurysm/AVM Conference to review the clinical information and radiographic studies of cases referred to Center physicians and reach a consensus about the diagnosis and optimal management for each patient. After the conference, staff members contact patients and physicians about recommendations for the next treatment step.

Proper Assessment Guides Proper Treatment
Aneurysm | Arteriovenous Malformation | Carotid Disease

The first step in providing optimal care often involves a choice between conservative treatment and intervention. Not all vascular malformations of the brain become symptomatic, and incidental discovery of a lesion does not necessarily demand treatment. However, some vascular malformations carry significant risk of hemorrhage. Choosing a treatment plan requires comparison of risks of the natural history and treatment.

At the UCSD Brain Aneurysm/AVM Center, recent advances in MRI, CTA, and angiography allow more precise anatomic localization of the aneurysm or AVM and greatly aid treatment planning. Superselective injection of intracranial vessels can better define the relationship of the aneurysm neck or identify feeding vessels to the AVM.

After careful analysis of the vascular studies and factors such as the patient’s age, clinical presentation and natural history, the multidisciplinary team develops a treatment plan.

Providing Optimal Treatment

The goal of treatment is complete elimination of the aneurysm or AVM. More patients can be safely treated with a multidisciplinary approach involving surgery, endovascular treatment and radiosurgery. Currently, several treatment modalities for aneurysm and AVM are used, either individually or in combination.

Endovascular Treatment

Endovascular treatment for AVMs involves the injection of acrylic material through slender microcatheters which can be navigated through the cerebral arteries to the abnormal vessels in the AVM. Some lesions, can be treated to obliteration; in others the strategy is to eliminate particularly dangerous components of the AVM as well as decrease volume of the lesions.

Endovascular treatment of aneurysms involves placement of tiny microcoils within the aneurysm to tightly pack off the lesion and eliminate it from the circulation.  This minimally invasive approach is suitable for for many aneurysm types and our specialists are expert in this form of therapy.

Surgery

Microsurgical techniques have been refined in the last decade to the extent that small, accessible lesions now can be removed or clipped at very low risk.

Radiosurgery

Small AVMs inaccessible to surgery can be eradicated effectively and at low risk using radiation. Stereotactic techniques used in conjunction with angiography allow physicians to identify the exact location of the AVM. High energy focused radiation in the form of proton beam can be directed to the center of the AVM to minimize injury to surrounding brain tissue.

Combined Therapies

Occasionally, surgical excision, radiosurgery or curative embolization alone successfully eliminates brain AVMs. But in most cases, combined treatments such as embolization-surgery or embolization-radiosurgery provide a safer more effective approach, improving chances for a complete cure.

 

 

SUPPORT GROUPS

Support groups for brain aneurysm patients meet regularly. Patients and their families meet with our nurse coordinator to share and discuss feelings and concerns. The meeting provides both an educational and emotional forum for its members. The Center's Nurse Clinician role is to assist group members in the recognition, acknowledgment and resolution of important issues. 

Brightening the Future of Therapy

AVM therapy has an exciting future. Better radiosurgical techniques may make it possible to treat larger lesions in critical areas of the brain using focused radiation therapy. Rapidly improving endovascular techniques are making previously inoperable lesions amenable to surgical resection or radiation therapy after pretreatment with embolization therapy. Developments in imaging technology are providing better definitions of AVM anatomy.

Aneurysm therapy is also advancing as new surgical techniques decrease treatment risks. The role of endovascular treatment is extremely promising and will also decrease treatment risk.

 

[3D Image Cerebrovascular Surgery]

 

Diagnosis and treatment of carotid disease has made great advances over the past few years. Noninvasive testing (MRI/MPA,Transcranial doppler studies) are now the standard diagnostic tools in evaluation of carotid disease. The arteriogram is only done in complex cases where the anatomy may not be well defined on the MRA.

For stroke therapy, a variety of new techniques are now available. Surgery for carotid endarterectomy provides protection front stroke if carotid artery narrowing is found in an, asymptomatic or symptomatic patient. In addition, if a stroke has occurred, new endovascular techniques of thrombolysis (clot disruption) are now available. Protocols utilizing brain protection and brain salvage are also available at the Aneurysm/AVM Center.

Research and refinement of new treatment techniques are also important aspects of neurocritical care: for example, researchers studying cerebral blood flow and perfusion hope to minimize damage to the brain from ischemia. As a service to New England physicians interested in the latest research, the Center publishes the Neurovascular News, a quarterly bulletin that highlights important research areas, provides reviews of fundamental topics and summarizes the latest research results. An annual Cerebrovascular Symposium is offered in collaboration with UCSD Medical School including the latest data on the care and management of patients with cerebral aneurysms and vascular malformations of both the brain and spinal cord.

ANEURYSM / AVM CLINIC

At the monthly meeting of the Aneurysm/ AVM Clinic, representatives front our neurosurgery, neurology, and interventional neuroradiology departments examine 15-20 new patients. The Clinic allows patients to consult immediately with their physicians and gives them direct access to the Nurse Coordinator.

The Best Care for Your Patients is Our Goal

Our staff members are dedicated to helping you provide routine and emergency care for your patients, whether the care involves consultations, treatment or follow-tip.

You will be continually briefed about the progress of your patients. And through our Nurse Coordinator, who serves as a liaison between you and your patient and us, you can count on someone always being available to take calls, answer questions and facilitate the care of all inpatients and outpatients.