The Comprehensive Center for Cerebrovascular Neurosurgery at the University of Pittsburgh Medical Center is a subspecialized multidisciplinary clinical unit that evaluates and treats all forms of vascular disorders of the brain and spinal cord. Given the high volume of cases managed by the center, it serves as a national and international resource for the management of patients with complex cerebrovascular disease, including aneurysms, arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), carotid disease, moyamoya disease, and cavernous malformations. With a group of highly subspecialized physicians, center faculty prospectively assess patients and provide broad state-of-the-art treatment options. Central to our mission is the belief that patients should have access to the entire spectrum of techniques. As such, our experts evaluate cases and provide recommendations with the goal of minimizing risks and maximizing long-term efficacy.
The center is directed by Michael J. Lang, MD, and also includes Robert Friedlander, MD, Paul A. Gardner, MD; Bradley A. Gross, MD; and Georgios Zenonos, MD. Dr. Gross also serves as director of endovascular neurosurgery for the center.
Challenging cases are reviewed prospectively in our weekly multidisciplinary cerebrovascular conference. Complex cases are analyzed systematically, in order to fully vet the microsurgical, endovascular, radiosurgical, and medical options for each case. Combined with assessment of patient clinical profiles by our dedicated multidisciplinary preoperative clinic, recommendations are made to prioritize long-term patient health and safety. This setting also provides exceptional educational opportunities for our fellows and residents as they advance their training.
The Cerebrovascular Center is proud to provide care for patients with hemorrhagic disease, such as aneurysms, arteriovenous malformations, and carvernous malformations, for some of the most complex and vulnerable patients in the country. Our endovascular neurosurgeons participate in nationwide clinical trials to evaluate developing technologies such as flow diverting stents and intra-saccular flow diversion. Dr. Gross is a contributor to a first-of-its-kind national consortium to advance the understanding of dural arteriovenous fistulas (dAVFs), a rare and uniquely challenging vascular malformation. Advanced imaging techniques developed at UPMC, such as high-density fiber tracking (HDFT), facilitate the safe resection of cavernous malformations in critical areas of the brain, such as the brainstem. Under Dr. Lang, the center has pioneered novel approaches to brain aneurysms by directly combining microsurgical and endovascular techniques. We have been able to offer definitive treatment to patients otherwise deemed incurable. As such, the Cerebrovascular Center is able to provide one of the busiest and fully immersive training programs in the country for our residents and fellows pursuing education in cerebrovascular surgery.
The Cerebrovascular Neurosurgery Center works in close collaboration with the UPMC Stroke Institute in the treatment of ischemic cerebrovascular disease—staffed by neurologists with additional training in vascular neurology. Our endovascular neurosurgeons and interventional neurologists perform acute interventions for ischemic strokes at one of the highest rates in the country and are involved in innumerable trials advancing the field. The Cerebrovascular Center provides comprehensive evaluation of patients with carotid stenosis. Patients are evaluated in multidisciplinary fashion to choose from an array of surgical options including carotid endarterectomy (CEA), carotid artery stenting (CAS), and transcarotid revascularization (TCAR). For patients with more complex, cerebral ischemic disease, Dr. Lang has developed one of the busiest cerebral revascularization practices in the country, offering cutting-edge cerebral bypass techniques, vascular transpositions, and other unique treatment options.
Ongoing research efforts at the Comprehensive Cerebrovascular Center continue to advance the field of vascular neurosurgery. Under Dr. Gross, UPMC served as one of the largest enrollers in the recently published EMBOLIZE trial, which has confirmed the benefits of treating chronic subdural hematomas (CDH) with endovascular embolization to reduce the need for surgical drainage and/or retreatment. We continue to participate in clinical trials to evaluate the most cutting edge treatments for brain aneurysms, and are helping to advance the use of neural stimulation to improve patient recovery after stroke.