For most cerebrovascular diseases, surgery plays a leading role in treatment. We may need to repair a damaged blood vessel or remove a blood clot. In nonemergency situations, surgery is often necessary to prevent the risk of bleeding (hemorrhage) or stroke.
Our cerebrovascular disease team provides expert treatment and follow-up care. We consider all options and recommend an approach that offers you the best chance for a positive outcome.
360-Degree Cerebrovascular Disease Treatment from a Multispecialty Surgical Team
Throughout your care, we surround you with comprehensive support from a multidisciplinary team of:
- Neurovascular surgeons perform brain microsurgery and other complex surgical procedures on the blood vessels in your brain and spine.
- Neurologists specialize in all types of disorders of the nervous system.
- Neuroanesthesiologists deliver anesthesia during neurovascular surgical procedures.
- Neurointensivists manage your care in our neurocritical care unit.
- Neurorehabilitation specialists help you regain function after treatment.
Our cerebrovascular disease team collaborates closely with each other and with specialists throughout the Penn Medicine system to ensure you get the care you need. At weekly cerebrovascular team meetings, we discuss new cases, review each patient’s diagnosis and determine the most appropriate plan for treatment. As needed, the team collaborates with doctors in other departments, such as rheumatology and oncology, to manage all aspects of your treatment.
Our comprehensive Stroke Center and Cavernous Malformations Center of Excellence are advanced centers of care that bring together dedicated personnel and resources to provide the highest level of care. These centers focus on enhancing patient outcomes through research and quality improvement.
Surgical Treatment Options for Cerebrovascular Diseases
When determining your treatment strategy, cerebrovascular specialists weigh many factors. Depending on your condition, age and overall health, we may recommend a minimally-invasive endovascular approach or microsurgery. Radiosurgery is an option less often, usually for smaller vascular malformations.
Minimally Invasive Brain Microsurgery
Brain microsurgery is a type of open surgery of the brain that uses an operating microscope and very small instruments. It requires an incision and removal of a section of your skull. The surgeon operates precisely, working around delicate nerves and areas of the brain that control essential functions.
We may recommend microsurgery to:
- Remove vascular malformations or tumors
- Reroute or restore blood flow
- Stabilize a brain aneurysm
Examples of the types of microsurgery we perform include:
Penn cerebrovascular surgeons are world-renowned and highly skilled in performing complex procedures. The operating rooms at Penn feature advanced technologies, such as computer-guided localization, MRI, and intraoperative monitoring. These tools help our surgeons navigate around fine nerves and essential areas of the brain.
Endovascular Neurosurgery
Endovascular neurosurgery is a less invasive cerebrovascular approach that provides treatment from inside your blood vessels. The doctor inserts a small tube (catheter) into a blood vessel in your leg or wrist.
Because it is less invasive, endovascular surgery can result in less pain, lower risk of complications and faster recovery. Examples of endovascular techniques include embolization, stenting and angioplasty.
Examples of endovascular techniques we offer include:
- Angioplasty and stenting of the carotid, vertebral and intracranial arteries
- Balloon occlusion testing to identify blocked arteries in the brain
- Embolization to stop blood flow to a brain aneurysm, arteriovenous malformation or dural arteriovenous fistula
- Flow diversion to treat a brain aneurysm
- Inferior petrosal sinus sampling to measure hormone levels produced by the pituitary gland, usually for the diagnosis of Cushing’s disease
- Middle meningeal artery embolization to treat chronic subdural hematomas
- Neck angiograms and embolization for facial or neck hemorrhages or injuries
- Selective intra-arterial medication infusion to treat brain tumors
- Transcarotid artery revascularization for carotid artery disease
- Tumor embolization of the brain or spine
- Venous stenting to improve blood flow through narrow or blocked veins
- Vertebral artery transposition to ensure blood flow to the brain in some patients undergoing aortic arch repair
- WADA testing for epilepsy evaluations
Our doctors also perform endovascular procedures for specific conditions, such as eagle syndrome, bow hunter syndrome and subclavian steal syndrome.
Radiosurgery
In radiosurgery, doctors apply radiation therapy from outside the body, without the need for incisions. At Penn Medicine, we offer Gamma Knife® radiosurgery to treat brain disorders.
Gamma Knife delivers a beam of highly focused radiation to a specific area of the brain with pinpoint accuracy. We use Gamma Knife mainly for arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs).
Neurocritical Care
After surgery, you may receive care in our neurocritical care unit. Penn Medicine has one of the highest-volume neurocritical care units in the U.S., staffed by a large, dedicated team. They provide close monitoring and expert management of any problems that occur in the hours and days after treatment.
We encourage your family to be at your bedside after surgery and the large, spacious rooms allow for this. Your doctor also sees you in the neurocritical care unit and coordinates with the team there.
Neurorehabilitation
Cerebrovascular diseases can damage the brain and cause a loss of function. You may experience problems walking, speaking or thinking. Cerebrovascular conditions can also affect your emotions. A Penn, we surround you with the resources you need to help you regain your independence.
Neurorehabilitation begins in the hospital and continues after you go home. Some people recover quickly, while others may need ongoing therapy. Our neurorehabilitation team is with you at every step, providing compassionate care and support.
World-Class Cerebrovascular Disease Treatment at Penn Medicine
Penn Medicine cerebrovascular disease experts are a highly experienced and collaborative team, with expertise in even the rarest disorders such as arteriovenous malformations and moyamoya disease. We believe there is an optimal treatment for every patient and work together to provide personalized medicine for all.
People from across the U.S. and around the world seek our help for many reasons:
- Surgical expertise and experience: Our neurovascular specialists are at the leading edge of cerebrovascular disease treatment. As a high-volume referral program, we have extensive experience managing the rarest and most complex cerebrovascular conditions.
- Modern facilities: Penn’s new hospital, called the Pavilion, features three hybrid operating rooms, each containing a full set of surgical, endovascular and imaging equipment, including a 3T MRI. The Pavilion also offers a healing, calming environment and hotel-like amenities.
- State-of-the-art medical imaging: Our specialists have access to the most advanced imaging systems to help you receive an accurate diagnosis. Find out more about cerebrovascular diagnosis and evaluation.
- Close follow-up: We have a large dedicated neurocritical care unit that works with your surgical team to manage any problems that arise after surgery. If you have lost function due to your condition, our comprehensive neurorehabilitation team is also here to help.
- Coordinated cerebrovascular care: Our specialists work closely with referring physicians to provide a rapid and thorough evaluation. Throughout your care, we share information about your treatment and progress with your regular physician to ensure coordinated care after surgery and beyond.
- Subspecialty support: The entire cerebrovascular surgery team, including advanced practice providers (APPs), nurses, coordinators and office staff, have subspecialty training. They have a deep understanding of your condition, challenges and needs.
Second Opinions for Your Cerebrovascular Disease Treatment
It’s common to have questions about your diagnosis or treatment plan. Penn’s neurovascular specialists are here for you to provide a second, or even third, opinion. Whether it’s a new diagnosis or you’ve already received treatment, we make sure you’re on the right path forward.
Our team carefully reviews your medical history and current diagnosis. During your consultation, we take time to make sure you and your family understand your condition and our recommendations.
Learn more about the Neurosurgery Second Opinion Program.
Request an Appointment
To make an appointment, please call 800-789-7366 or request a callback.