Treatments for cerebrovascular disorders
- Aneurysm surgery
- Endovascular aneurysm surgery
- AVM surgery
- Carotid stenting
- Carotid endarterectomy
- Intra-cranial cerebral angioplasty and stenting
- Cerebral revascularization
- Intravenous and intra-arterial thrombolysis and mechanical thrombectomy
- Cytoprotective agents
- Treatment of hemorrhagic stroke
- High-flow bypass for unclippable aneurysms
- Low-flow bypass for Moyamoya disease and atherosclerotic ischemic disease
- Surgery under circulatory arrest
For hemorrhagic strokes due to ruptured aneurysms or arteriovenous malformations, a full array of cerebrovascular and endovascular surgical techniques are available from Geisinger specialists, including radiosurgery. Geisinger specialists are among the most experienced cerebrovascular neurosurgeons in the country, and employ the latest open, skull base approaches, computer-assisted minimally invasive craniotomy and endovascular surgical techniques.
Open cerebrovascular surgery
Geisinger provides open cerebrovascular surgery for the treatment of brain aneurysms, AVMs, cavernous malformations as well as stroke and ischemic disease. Surgical clipping is performed for aneurysms not amenable to cure by endovascular means and for younger patients due to longer durability and higher cure rate.
Geisinger neurosurgeons also offer cerebral revascularization (bypass), a unique service provided at Geisinger’s Neurosciences Institute. Few centers in the United States offer this procedure, and our neurosurgeons perform 10 to 12 revascularization procedures annually. Geisinger also offers state-of-the-art surgical technology, including intraoperative ICG angiography. In late 2011, Geisinger will acquire the ELANA device, to perform non-occlusive bypass procedures to treat giant or untreatable aneurysms deep in the brain. Geisinger Neurosurgery will be the only Department in Pennsylvania to offer the ELANA procedure.
Interventional neuroradiology and endovascular neurosurgery
Geisinger neurosurgeon's expertise includes the full range of diagnostic and interventional techniques. For vascular lesions, they may use GDC or other coils, particulate agents or liquid embolic agents. Other definitive or adjunct endovascular therapies offered include intra-arterial thrombolysis for acute stroke, intra-cranial cerebral angioplasty and stenting, carotid artery stenting and AVM or tumor pre-operative embolization.
Treatment of ischemic disease
Today, therapy for acute ischemic stroke may involve thrombolysis, mechanical thrombectomy, cytoprotective therapy or anticoagulant therapy. Geisinger cerebrovascular specialists were among the first in the world to utilize thrombolysis in acute stroke.
Cerebral ischemia due to cardioembolic disorders, small-vessel occlusive disease, vertebral or carotid dissection, and hematologic or other causes is generally treated with escalated medical therapy, open or microsurgical procedures including, endovascular angioplasty and stenting, revascularization or a combination of the three. When ischemic strokes cause life-threatening brain swelling, surgical decompression may improve outcome. Geisinger specialists direct the surgical portion of a national multicenter trial to determine the benefits of surgical approaches to brain swelling from stroke.
Under the direction of two intensivists, a team of critical care physicians prevents and treats cerebral edema, increased intracranial pressure, cerebral vasospasm and other potentially lethal complications of cerebrovascular disease. Aggressive prevention and treatment protocols, plus transcranial Doppler blood-flow velocity monitoring have reduced subarachnoid hemorrhage and stroke mortality.
Each year, Geisinger specialists treat many patients with carotid stenosis, unruptured aneurysms including giant lesions and asymptomatic AVMs to prevent future rupture. Open cerebrovascular, skull-base surgical techniques and endovascular options, along with complex bypass reconstructions with saphenous vein interposition bypass grafting, have increased safety and improved outcomes. Customized programs are also available to reduce modifiable risk factors, such as hypertension, hyper-cholesterolemia and smoking.
Comprehensive neurorehabilitation and long-term, risk-factor modification programs are available through the Geisinger Cerebrovascular Center. Through physical therapy, patients learn to maximize their function and resume normal activities to the fullest extent possible.
Sharing expertise through education
Contributing to quality patient care are the highly sought-after fellowships and residencies offered through Geisinger. As a result, tomorrow's practitioners are exposed to the newest investigational drug therapies, as well as to diagnostic, endovascular and surgical approaches to stroke and other cerebrovascular diseases.
National and international CME symposia and grand rounds lectures on neurological, vascular surgery, neurosurgical and neuroscience topics are also sponsored by Geisinger’s Neurosciences Institute to keep the medical community abreast of the latest developments.