[vlhperry]

Dear Fellow Forum Readers,

The field of neurology is rapidly changing. Movement Disorder Specialists is no longer the preferred physician for Parkinson's Disease patients. The new category that Parkinson's is now defined under is Cerebrovascular Disorders. Specific physicians are beginning to train in this area. Parkinson's Disease is still in the infancy state of this study, still trying to figure out the genitics of the disorder.

Cerebrovascular Disorders

Clinical Neuro-Oncology

[CENTER][LIST][*]Epilepsy [*] Functional Neurosurgery [*] Radiosurgery Program [*] Movement Disorders and Parkinson's [*] Nerve Injury [*] Neurospinal Disorders [*] Pain Management [*] Pediatric Neurological Surgery Program [*] Pituitary Treatment [*] Subservices [*] Surgical Neurophysiology [*] Neurosurgery Research[LIST][Center]

Cerebrovascular Disorders Program

Surgical management of cerebrovascular disorders is coordinated through the UCSF Center for Stroke and Cerebrovascular Disease, a multidisciplinary program at the UCSF Medical Center involving more than 30 specialists including neurosurgeons, neurologists, and interventional neuroradiologists. The Center offers a complete spectrum of therapies to meet individual patient needs with the highest degree of quality, and is accessible at all times to physicians for consultation, referrals (877/BRAIN-1-1), and transfers.

The Center for Stroke and Cerebrovascular Disease has become the leading referral center for cerebrovascular disease in the northern California region, caring for more than 300 aneurysm patients and more than 75 arteriovenous malformation (AVM) patients annually.

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

• Surgical Management of Aneurysms
• Surgical Management of Arteriovenous Malformation (AVM)
• Surgical Treatment of Vascular Malformations
• Surgical Treatment of Ischemic Disorders
• Activities at the UCSF Center for Stroke and Cerebrovascular Disease

Surgical Management of Aneurysms

Aneurysms occur in a variety of locations in the brain. Specialized surgical approaches exist to deal with this spectrum of aneurysms. Microsurgical technique is the basis for successful surgical treatment of aneurysms. Aneurysms that lie in subarachnoid spaces and fissures outside the brain can be accessed by carefully opening these natural corridors. Skull base surgery, which utilizes corridors through the bone of the base of the skull, is commonly used for deep and difficult aneurysms. Newer modalities 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.

Surgical Management of Arteriovenous Malformation (AVM)

Most arteriovenous malformations (AVMs) are treated with microsurgical resection. The safety and efficacy of surgery is enhanced by preoperative embolization, an endovascular procedure that selectively catheterizes arteries feeding into an AVM and occludes them with particles or glue. This preoperative technique decreases the flow through an AVM and facilitates its surgical removal. While most AVMs can be treated in this manner, those that are not surgically accessible are treated with stereotactic radiosurgery, or the Gamma Knife®. This approach uses radiation targeted precisely to the AVM to induce changes in the arteries that, over time, occlude them.

Surgical Treatment of Vascular Malformations

Treatment of dural arteriovenous fistulae (DAVF): These lesions are abnormal artery-to-vein connections in the dura that overlies the brain. DAVFs can usually be treated endovascularly by occluding feeding arteries with embolic agents, or by occluding the venous sinuses on which these fistulas are based. For lesions that are not completely obliterated with endovascular methods, surgery is used to finish the treatment.

Treatment of cavernous angioma: These malformations of capillaries and veins are rare, causing seizures or acute, focal neurological deficits that vary with the lesion location. Cavernous angiomas vary in size from a few millimeters to several inches in diameter. These lesions are managed surgically when they are accessible, enabling removal of the malformation and often curing the seizures. Surgical resection requires careful strategy to reach the lesion without going through any vital brain tissue, often relying on intraoperative computer navigation.

Surgical Treatment of Ischemic Disorders

A stroke occurs every minute. Death from stroke occurs every three minutes. The UCSF Center for Stroke and Cerebrovascular Disease is committed to the rapid diagnosis and treatment of stroke. A physician-to-physician hotline (877/BRAIN-1-1) is available 24 hours a day, seven days a week for emergency consultations, referrals, and transfers to UCSF Medical Center.

Radiological evaluation with CT scan, MR imaging and/or angiography is performed promptly to establish a diagnosis within the window for therapeutic intervention, and neurosurgery is available at any time. After extensive evaluation by the Center's team, patients who experience cerebrovascular insufficiency who cannot be treated medically are considered candidates for carotid endarterectomy or extracranial-to-intracranial (EC-IC) bypass surgery.

1. . Carotid endarterectomy - This surgery is helpful in preventing stroke in patients with symptomatic or asymptomatic narrowing of the carotid artery greater than 50 percent. During surgery, the exposed carotid artery is temporarily clamped while the atherosclerotic material is removed and the artery is stitched closed. The clamp is then removed and flow is restored to the artery.
2. . EC-IC bypass surgery - This technique is a promising option for high-risk patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Clinical trials have demonstrated a reduction in subsequent stroke for patients following this surgical intervention.

Activities at the UCSF Center for Stroke and Cerebrovascular Disease

Conference - Wednesdays 12PM

Physicians are invited to attend, present clinical cases, or mail in cases for presentation. Films should be mailed with a brief clinical summary to:

Michael Lawton MD
UCSF Cerebrovascular Disorders & Stroke Program
505 Parnassus Avenue, M-780
San Francisco, CA 94143-0112

The Stroke Team will evaluate these cases, respond promptly by phone, and return all films by mail.

Continuing Medical Education Programs

Members of the UCSF Center for Stroke and Cerebrovascular Diseases are available to present continuing medical education programs. If you are interested in these activities, please call the toll-free hotline number, 877.BRAIN.1.1.



Associated Faculty
Director
Michael T. Lawton MD

• Faculty Practitioner
• Philip R. Weinstein MD
• Gamma Knife® Radiosurgery
• Michael W. McDermott MD
• Patricia Sneed MD David A. Larson MD, PhD (emeritus)
• Clinical Nurse Specialist
• Lisa Hannegan RN, MS
• Interventional Neuroradiology
• Randall T. Higashida MD
• Christopher F. Dowd MD
• Van V. Halbach MD
• Neuroanesthesia
• William L. Young MD
• James E. Caldwell MD
• Lawrence Litt MD, PhD
• Pekka Talke MD
• Neurophysiology
• Charles D. Yingling PhD
• Russ Lyon MS, DABNM
• Roger S. Noss PhD
• Mizrza Alam MD, DABNM
• Neuroradiology
• William P. Dillon, Jr. MD
• Anthony J. Barkovich MD
• Neurovascular and Neurocritical Care Service
• Wade S. Smith MD
• David C. Bonovich MD
• S Claiborne Johnston MD
• Vineeta Sing MD
• J. Claude Hemphill III MD
• Nerissa Ko MD
• Cerebrovascular Disorders Program
• Department of Neurological Surgery
• University of California San Francisco
• UCSF Medical Center, A-808
• 400 Parnassus Avenue, Box 0350
• San Francisco, CA 94143-0350
• tel 415.353.7500; fax 415.353.2889
• toll free 877.BRAIN.1.1

To contact the UCSF Department of Neurological Surgery with questions about medical matters, call 415-353-7500 or fax 415-353-2889.

For information about the UCSF Neurological Surgery Residency Program, call 415-353-3904 or fax 415-353-3907.

Copyright ©2003 UCSF Neurosurgery. All rights reserved.

[GregD]

Oh, great! I can't get a Movement Disorder Specialist to treat me properly now I have to brake in a Cerebrovascular Disorder Specialist that is even more confused.

GregD

[olsen]

Movement disorder specialty is a relatively new branch of neurology. The training program in this subspecialty was started by Dr. Stanley Fahn who is at NYU med center at present, a neurologist in Tx and one in France (whose names I do not recall). Cerebrovascular diseases' major area of interest is strokes or "cerebrovascular accidents" and vascular abnormalities. I cannot imagine why parkinson's would be placed under that umbrella.......esp since only vascular PD may apply; idiopathic PD is not thought to be vascular in origin, which makes up the largest % of patients diagnosed with PD. Vicky, where did you receive your information? the reproduced article did not place PD under cerebrovascular diseases. thanks, madelyn

[ol'cs]

The diagnosis of "parkinsonism". Vicky, shouldn't these signs be readily seen on MRI or CT scanning of the brain, which most of us get "to rule out tumors" but "cannot image PD" as we are told by our doctors before we get a SPECT or an F-Dopa PET scan to further clinch a "PD dx"?
Maybe they can see more than than they are looking for by using the preliminary scanning tools, thigs that woud implicate damage taht is ultimately connected with "parkinsonism". cs