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Cerebrovascular Disorders Program
Home > Patient Care > Cerebrovascular Disorders Program

Obstructed blood vessel
Surgical management of cerebrovascular disorders is coordinated through the UCSF Center for Stroke and Cerebrovascular Disease, a multidisciplinary program at the UCSF Medical Center involving more than 30 specialists including neurosurgeons, neurologists, and interventional neuroradiologists. The Center offers a complete spectrum of therapies to meet individual patient needs with the highest degree of quality, and is accessible at all times to physicians for consultation, referrals (877/BRAIN-1-1), and transfers.
The Center for Stroke and Cerebrovascular Disease has become the leading referral center for cerebrovascular disease in the northern California region, caring for more than 400 aneurysm patients and more than 75 arteriovenous malformation (AVM) patients annually.
Many cerebrovascular disorders can be successfully treated with surgery, eliminating the threat of hemorrhage and the risk of death.
Surgical Management of Aneurysms
Surgical Management of Arteriovenous Malformation (AVM)
Surgical Treatment of Vascular Malformations
Surgical Treatment of Ischemic Disorders
Activities at the UCSF Center for Stroke and Cerebrovascular Disease
Surgical Management of Aneurysms
Aneurysms occur in a variety of locations in the brain. Specialized surgical approaches exist to deal with this spectrum of aneurysms. Microsurgical technique is the basis for successful surgical treatment of aneurysms. Aneurysms that lie in subarachnoid spaces and fissures outside the brain can be accessed by carefully opening these natural corridors. Skull base surgery, which utilizes corridors through the bone of the base of the skull, is commonly used for deep and difficult aneurysms. Newer modalities for treating aneurysms, namely occluding them with platinum coils packed inside the aneurysm, are available for selected cases. Complex and giant aneurysms that cannot be treated with conventional clipping or coiling techniques are treated with more intricate procedures, including bypass operations that resupply blood flow to arteries downstream from the aneurysm so that upstream arteries filling the aneurysm can be occluded.
Surgical Management of Arteriovenous Malformation (AVM)
Most arteriovenous malformations (AVMs) are treated with microsurgical resection. The safety and efficacy of surgery is enhanced by preoperative embolization, an endovascular procedure that selectively catheterizes arteries feeding into an AVM and occludes them with particles or glue. This preoperative technique decreases the flow through an AVM and facilitates its surgical removal. While most AVMs can be treated in this manner, those that are not surgically accessible are treated with stereotactic radiosurgery, or the Gamma Knife®. This approach uses radiation targeted precisely to the AVM to induce changes in the arteries that, over time, occlude them.
Surgical Treatment of Vascular Malformations
Treatment of dural arteriovenous fistulae (DAVF): These lesions are abnormal artery-to-vein connections in the dura that overlies the brain. DAVFs can usually be treated endovascularly by occluding feeding arteries with embolic agents, or by occluding the venous sinuses on which these fistulas are based. For lesions that are not completely obliterated with endovascular methods, surgery is used to finish the treatment.
Treatment of cavernous angioma: These malformations of capillaries and veins are rare, causing seizures or acute, focal neurological deficits that vary with the lesion location. Cavernous angiomas vary in size from a few millimeters to several inches in diameter. These lesions are managed surgically when they are accessible, enabling removal of the malformation and often curing the seizures. Surgical resection requires careful strategy to reach the lesion without going through any vital brain tissue, often relying on intraoperative computer navigation.
Surgical Treatment of Ischemic Disorders
A stroke occurs every minute. Death from stroke occurs every three minutes. The UCSF Center for Stroke and Cerebrovascular Disease is committed to the rapid diagnosis and treatment of stroke. A physician-to-physician hotline (877/BRAIN-1-1) is available 24 hours a day, seven days a week for emergency consultations, referrals, and transfers to UCSF Medical Center.
Radiological evaluation with CT scan, MR imaging and/or angiography is performed promptly to establish a diagnosis within the window for therapeutic intervention, and neurosurgery is available at any time. After extensive evaluation by the Center's team, patients who experience cerebrovascular insufficiency who cannot be treated medically are considered candidates for carotid endarterectomy or extracranial-to-intracranial (EC-IC) bypass surgery.
. Carotid endarterectomy - This surgery is helpful in preventing stroke in patients with symptomatic or asymptomatic narrowing of the carotid artery greater than 50 percent. During surgery, the exposed carotid artery is temporarily clamped while the atherosclerotic material is removed and the artery is stitched closed. The clamp is then removed and flow is restored to the artery.
. EC-IC bypass surgery - This technique is a promising option for high-risk patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Clinical trials have demonstrated a reduction in subsequent stroke for patients following this surgical intervention.
Activities at the UCSF Center for Stroke and Cerebrovascular Disease
Conference - Wednesdays 12PM
Physicians are invited to attend, present clinical cases, or mail in cases for presentation. Films should be mailed with a brief clinical summary to:
Michael Lawton MD
UCSF Cerebrovascular Disorders & Stroke Program
505 Parnassus Avenue, M-780
San Francisco, CA 94143-0112
The Stroke Team will evaluate these cases, respond promptly by phone, and return all films by mail.
Continuing Medical Education Programs
Members of the UCSF Center for Stroke and Cerebrovascular Diseases are available to present continuing medical education programs. If you are interested in these activities, please call the toll-free hotline number, 877.BRAIN.1.1.
Associated Faculty
Michael T. Lawton MD
Faculty Practitioner
Philip R. Weinstein MD
Gamma Knife® Radiosurgery
Michael W. McDermott MD
Patricia Sneed MD
David A. Larson MD, PhD (emeritus)
Clinical Nurse Specialist
Lisa Hannegan RN, MS
Interventional Neuroradiology
Randall T. Higashida MD
Christopher F. Dowd MD
Van V. Halbach MD
William L. Young MD
James E. Caldwell MD
Lawrence Litt MD, PhD
Pekka Talke MD
Charles D. Yingling PhD
Russ Lyon MS, DABNM
Roger S. Noss PhD
Mizrza Alam MD, DABNM
William P. Dillon, Jr. MD
Anthony J. Barkovich MD
Neurovascular and Neurocritical Care Service
Wade S. Smith MD
David C. Bonovich MD
S Claiborne Johnston MD
Vineeta Sing MD
J. Claude Hemphill III MD
Nerissa Ko MD
Cerebrovascular Disorders Program
Department of Neurological Surgery
University of California San Francisco
UCSF Medical Center, A-808
400 Parnassus Avenue, Box 0350
San Francisco, CA 94143-0350
tel 415.353.7500; fax 415.353.2889
toll free 877.BRAIN.1.1

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