Cerebrovascular Surgery and the Comprehensive Stroke CenterThe Division of Cerebrovascular Surgery, in conjunction with the Comprehensive Stroke Center at the University of Virginia Medical Center, and a team of endovascular neuroradiologists, provides the highest level of comprehensive care for patients with cerebrovascular emergencies, diseases and disorders. Drs. Neal Kassell and Aaron Dumont provide extensive experience in the management of all cerebrovascular disorders, including ruptured and unruptured intracranial aneurysms, vascular malformations, intracerebral hemorrhages, carotid artery disease and diseases of the brain requiring bypass surgery. Diagnosis
A multidisciplinary team evaluates each patient for an accurate and precise diagnosis and then formulates a management plan individualized to each patient. Ischemic StrokeThe acute stroke intervention team is staffed by health care providers trained specifically in stroke medicine, and stroke neurologists and neurosurgeons who are on call 24 hours a day to assess and treat acute stroke. For patients with ischemic (clotting) strokes (85% of all strokes) who can get to UVa within three hours, our team is skilled in giving intravenous t-PA that can often reverse the stroke process. Intra-arterial thrombolysis is available for selected patients with large intracranial arterial occlusions out to six hours from onset. In addition, basilar artery thromboses can be treated with intra-arterial thrombolysis out to 24 hours. Angioplasty can be done before or after stroke for initial or recurrent stroke prevention, and carotid and cerebral stents are also available. Learn more about types of strokes, warning signs and prevention at UVA Neurology's stroke page. Aneurysms and Hemorrhagic StrokesA cerebral aneurysm (also called an intracranial aneurysm or brain aneurysm) is a bulging, weakened area in the wall of an artery in the brain, resulting in an abnormal widening or ballooning. Because there is a weakened spot in the artery wall, there is a risk for rupture and hemorrhagic bleeding. When an artery ruptures and bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients, causing brain damage or death if not treated in time. There are two primary surgical treatments for a cerebral aneurysm: Clipping, where the neurosurgeon removes part of the skull, exposing the aneurysm, and places a metal clip across the neck of the aneurysm to prevent blood flow into the aneurysm sac. Dr. Neal Kassell has performed upwards of 40% of these done in Virginia in a year. Coiling, a minimally invasive endovascular technique, where a catheter is advanced from a blood vessel in the groin up into the blood vessels in the brain, and very tiny platinum coils are then advanced through the catheter into the aneurysm to fill it and prevent rupture. Drs. Aaron Dumont, Lee Jensen, and Avery Evans have teamed to perform more than 40% of these done in the state of Virginia. Intracerebral HemorrhageIntracerebral hemorrhage (ICH) is relatively common, often related to hypertension, and typically seen in specific regions, such as the basal ganglia, thalami, pons and cerebellum. Other causes include cerebral amyloid angiopathy, hemorrhagic transformation of infarction, tumors, anticoagulation, drugs such as cocaine, aneurysms and AVMs. Neurosurgeons at the University of Virginia are involved in the care of all patients admitted with ICH. Acute treatment in the intensive care unit is aimed at stabilization, and subsequent subacute and chronic treatment is undertaken for rehabilitation and treatment of underlying disorders. Patients are managed by aggressive medical treatment and with surgery in selected instances in which patients become refractory to medical management. Vascular MalformationsAn Arteriovenous Malformations (AVM)s are is an abnormal collection of blood vessels which obstruct certain tissue from receiving nutrients in the normal course of blood circulation, and can be prone to bleeding and cause severe and often fatal strokes. AVMs are one seventh as common as cerebral aneurysms with between 2,500 to 3,000 new cases presenting each year, and an estimated 280,000 patients afflicted in the United States. AVMs most frequently present as a consequence of hemorrhage in patients in their third and fourth decades. Additionally, patients may present with the new onset of Seizures, headache, or progressive neurological deficit or cognitive decline. Comprehensive management of patients harboring AVMs involves three main therapeutic modalities: endovascular therapy, microsurgery and stereotactic radiosurgery. To learn more about AVMs and Cavernous Malformations, click here.
FacilitiesFacilities for patient care include the Nerancy Neuro Intensive Care Unit; the Stroke Center ward with fully equipped diagnostic and interventional neuroradiology suites; the Lars Leksell Center for Gamma Knife Surgery; and neurosurgical operating rooms equipped with the latest technology. State-of-the-art equipment including new microscopes with high-definition video and computer software, frameless stereotactic navigation systems, advanced endoscopic equipment, intra-operative ultrasound and capabilities for intra-operative angiography are all at the disposal of the surgical team. All facilities are staffed by highly skilled personnel committed to excellence in patient care. Advanced ResearchThe division is also dedicated to improving future care and outcomes through clinical and laboratory research, as well as through the education of tomorrow's health care providers. We are conducting ongoing clinical and laboratory research to examine subarachnoid hemorrhage, cerebral vasospasm, ischemic stroke, intracerebral hemorrhage and endovascular and minimally invasive therapies.When appropriate, patients are evaluated and offered the most current and promising treatments available through the clinical trials program.
Vascular Conferences Recovery and Special ServicesPatients undergo recovery in the Nerancy Neuro Intensive Care Unit and in the Stroke Unit – units with staff trained specifically for the care of patients in need of intensive observation following a stroke. The nurses understand the unique medical requirements of patients recovering from various types of stroke. Physical, occupational and speech therapists work entirely with patients who are overcoming strokes and other neurological problems. Additionally, social workers assist patients with a range of needs, from returning to work after a stroke to dealing with social and medical issues following a major cerebral injury.Patients who have suffered a stroke and their families may be under a great deal of stress or in need of additional assistance. See UVA's Patient Information page to learn about all the patient and guest services available to make your stay as comfortable as possible. Children who suffer strokes receive treatment and rehabilitation in conjunction with the special services of UVa’s Kluge Children’s Rehabilitation Center. ContactNeal F. Kassell, M.D.Aaron Dumont, M.D. Jennifer Edwards, NP at 434-924-2735 or 800-924-2735 |
MRI scanners with capabilities for diffusion and perfusion imaging, and CT perfusion and PET scanners. Additionally, an angiography suite is available for diagnostic angiograms with the capability for 3-D reconstructions and planning. With a precise diagnosis established, each case is discussed among members of the team and the different therapeutic options are presented to patients and their families.
