Cerebrovascular Surgery


What is a cerebral aneurysm?
A cerebral aneurysm can best be described as a balloon-like sac that arises from the wall of an arterial blood vessel supplying the brain. There are four types of aneurysms, and they can all vary in severity. They include:

Saccular : This is the most common type of aneurysm. They occur at sites where the vessel wall is weakened by stress, typically at a point where the artery forms branches to supply the brain. This type of aneurysm affects about 3% of the adult population and becomes more frequent with age.
Dissecting: This is the second most common type of aneurysm, and can occur at any age. Artery walls are composed of multiple overlapping layers — a dissecting aneurysm occurs when the inner layers are damaged allowing blood to enter into outer layers.
Mycotic: These aneurysms are a result of localized infection in the arterial wall. The infection leads to damage of the wall, which we often associate with infections of the heart valves, such as bacterial endocarditis.

Pseudoaneurysm : This type of aneurysm is caused by trauma to the head that results in direct damage, and weakening of the arterial wall.

What are the most common types of treatments for aneurysms?
There are multiple approaches to consider for the treatment of aneurysms. Depending on the size and location of the aneurysm, procedures may include microsurgery for clipping of the aneurysm neck, endovascular coiling, or stenting for obliteration of the aneurysm dome, or a combination of microsurgical and endovascular procedures.


What is a cavernous malformation?
Cavernous malformations are abnormal clusters of blood vessels that form in the tissue of the brain. These clusters have a tendency to leak blood into the surrounding healthy brain. These hemorrhages in the brain can cause a range of serious complications, including stroke and seizure.

What are the most common types of treatments for cavernous malformations?
We select from several microsurgical treatment options to access the portion of the brain where the cavernous malformation has formed, and remove the blood vessels that are at increased risk of hemorrhaging.


What is carotid artery disease?
Carotid artery disease is the narrowing of the arteries in the neck, which is a leading cause of stroke. Stroke is literally the death of brain tissue because of a lack of blood supply to a particular part of the brain. Carotid artery disease can produce stroke when the atherosclerotic plaque or blood clots at the site of narrowing break off and migrate into the arteries of the brain.

What are the two most common types of treatments for carotid artery disease?
We rely on several effective approaches to treating this disease: carotid endarterectomy, and carotid angioplasty and stenting. Carotid endarterectomy entails surgically opening the neck, and then the artery, in order to remove the plaque within the vessel.

The second treatment, carotid angioplasty and stenting, involves threading a small balloon and metallic stent from the artery in the leg up to the carotid artery. The balloon is inflated to open the narrowed artery and then the stent (a small mesh-like metal tube) is deployed in order to keep the artery open. We will determine the best approach for you based on your overall health and prior history of neck or carotid artery surgery.


What is Moyamoya Disease?
Moyamoya Disease is a rare disorder that affects the blood vessels of the brain. It causes the walls of the main arteries of the brain (carotid arteries) to become thickened and narrowed, which can lead to stroke.

What are the most common types of treatments for Moyamoya Disease?
The majority of Moyamoya patients are treated with anti-platelet medications such as Aspirin. Most patients ultimately require a type of bypass surgery to improve the compromised blood flow to the brain. Various procedures can be performed, including those that form direct connections between arteries such as the STA-MCA bypass, and indirect procedures where brain revascularization occurs from donor tissues placed on the surface of the brain. These bypass procedures can help stop common stroke symptoms for Moyamoya patients.


What is an arteriovenous malformation (AVM)?
An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels inside the brain or spinal cord, which can compromise blood flow to the surrounding tissue and eventually result in hemorrhage and injury or damage. An AVM can occur in any part of the brain or spine.

What are the most common types of treatments for AVMs?
AVM treatment will vary depending on symptoms, the location of the blood vessels, and the size of the cluster. Craniotomy (which involves removing a small piece of the skull) is the most common approach, often performed in conjunction with endovascular embolization, which involves treating the AVM through a small catheter designed to block individual arteries of the AVM.
Finally, if the AVM is small, your neurosurgeon may recommend stereotactic radiosurgery, which precisely targets the affected blood vessels with radiation.


What is a dural arteriovenous fistula (DAVF)?
The dura is a thin, leathery layer of tissue that covers the brain and spinal cord. It has a rich arterial supply and the main venous drainage from the brain is through channels in the dura known as sinuses. Occasionally a direct connection (a fistula) can develop between the dural arteries and the draining veins or sinuses creating a kind of “short circuit” in the circulation. When untreated, DAVFs can cause bleeding in the brain or spinal cord, or cause neurological injury by impairing the normal blood flow in the central nervous system.

What are the most common types of treatments for dural arteriovenous fistulas?
The most common treatments are catheter-based techniques, in which the abnormal artery to vein connection is closed.