Neurovascular

Purpose/Goals

The Yale Neurovascular Program is committed to clinical excellence, superlative technical performance and innovation in diagnosis and therapy. The Program is entrusted with all facets of management of stroke and cerebrovascular disorders and the coordination of subsequent therapeutic strategies including surgery, interventional neuroradiology, stereotactic radiation (Gamma Knife Surgery), and rehabilitation. The Program is an integral part of the multi-disciplinary Yale Cerebrovascular Center, which includes the Vascular Neurology and Interventional Neuroradiology Programs. Together, these resources create a Neurovascular Program unique in breadth and depth nationally with latest techniques and modalities not available elsewhere in Southern New England. Among special services provided is the diagnosis and treatment of the following:

Aneurysms

Microsurgery and Endovascular Coiling

Vascular malformations

Acute stroke and occlusive disease management including

Carotid disease- Carotid Endarterectomy and Stenting

The Neurovascular Surgery Program and NICU operate at the center of critical multidisciplinary interfaces related to cerebrovascular disease and acute brain injury.

In addition to the research collaborations, there are essential clinical collaborations integrating outpatient evaluations and the inpatient clinical service with the Vascular Neurology Program. A single phone number is used for patient access with clinical coordinators from both programs deciding whether the patient should be seen by a vascular neurosurgeon, a vascular neurologist or both, often arranged at the same clinic.

On the inpatient service, hemorrhagic stroke patients and cases with stroke and multisystem disease or elevated cranial pressure are managed jointly with the Neurology Service and the Stroke Service.

A weekly multidisciplinary Cerebrovascular Conference is an essential core of multidisciplinary case discussions, and includes participation from the vascular neurology, neurovascular surgery and vascular neuroradiology programs, as well as attendance by other services and by community referring physicians. Discussions are clinically based and allow refinements of ongoing inpatient and outpatient protocols. Weekly lectures allow discussion of a variety of related clinical and basic science topics and review of the relevant literature in regular journal clubs.

Other interactions with the Department of Surgery include collaboration in the Trauma Program where neurosurgical residents respond acutely to every case of major trauma for prompt neurologic evaluation. All neurosurgery residents have achieved certification by the Advanced Trauma Life Support course during this year. We also provide neurosurgical input at multidisciplinary trauma conferences and quality improvement seminars.

An ongoing collaboration with the Yale Section of Ear Nose and Throat Surgery allows the management of complex head and neck tumors involving the carotid artery. Controlled therapeutic occlusion of the internal carotid artery is frequently undertaken under a strict management protocol designed to minimize complications and study the consequences of this drastic neurovascular intervention. Collaborations with the Department of Diagnostic Radiology span the full range of clinical and research activities of our Program, including management of ischemic and hemorrhagic stroke, and close collaboration in the management of every case undergoing therapeutic neuroradiologic intervention.

The Multidisciplinary Yale AVM group includes the largest volume of clinical cases with hereditary hemorrhagic telangiectasia in the United States, and provides comprehensive multidisciplinary management of this rare entity.