Vascular and Endovascular Center

Surgeons

Adel M. Malek, MD, PhD

James Kryzanski, MD

State-of-the-art biplane angiography suites provide outstanding imaging, including three-dimensional angiographic reconstruction. Depending on the particular patient, we are able to treat with conventional surgical techniques, endovascular techniques or stereotactic radiosurgery.

Surgery is often the preferred method of treatment, depending on the size and configuration of the aneurysm or AVM. Endovascular treatment, which involves coiling aneurysms or gluing AVMs, is a newer technique that provides a method of preventing hemorrhage without the need for an operation.

Radiosurgery may be used for those lesions that cannot be treated by the other methods.

Many cerebrovascular disorders can be successfully treated with surgery, eliminating the threat of hemorrhage and the risk of death.

Intracranial Aneurysms

Arteriovenous Malformation (AVM)

Cavernomas and dural arteriovenous fistulae

Treatment of Atherosclerosis and other ischemic disorders

Surgical Management of Aneurysms

Aneurysms occur in a variety of locations in the brain and a number of specialized surgical approaches exist to treat various aneurysms. Microsurgical technique is the basis for successful surgical treatment of aneurysms. Aneurysms which lie in subarachnoid spaces and fissures outside the brain tissue can be accessed and treated by carefully opening these natural corridors. Skull base surgery, which utilizes corridors through the bone of the base of the skull, is a treatment modality used for deep and difficult aneurysms. Newer ways 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.

Arteriovenous Malformation (AVM)

Most arteriovenous malformations (AVMs) are treated with microsurgical resection. The safety and efficacy of surgery may be enhanced by an endovascular procedure that selectively catheterizes arteries feeding into an AVM and occludes them, thereby reducing the blood flow through the malformation and decreasing the surgical risk of removal. While most AVMs can be treated in this manner, those that are not surgically accessible maybe treatable with stereotactic radiosurgery (Gamma Knife).

Cavernomas and dural arteriovenous fistulas

Treatment of cavernous angioma, a rare malformations of small vessels, varying in size from millimeters to centimeters in diameter. When feasible these lesions may be managed surgically, utilizeing a carefuly planned approach to reduce the risk to the surrounding brain tissue. Dural arteriovenous fistulae (DAVF) represent abnormal artery-to-vein connections within the dural cover of the brain. Usually they are treated endovascularly, some in combination with surgery by occluding feeding arteries with embolic agents.

Treatment of atherosclerosis and other ischemic disorders

Intracranial and extracranial angioplasty and stent placement for severe atherosclerotic disease that continues to be symptomatic despite optimal medical management is a way to prevent further damage from transient ischemic attacks or infarction.

This page last updated: Thursday, June, 01 2006