The Program is a model academic clinical specialty service entrusted with all facets of management of cerebrovascular disorders at the Yale-New Haven Medical Center and the West Haven Veterans Administration Medical Center, and with the operation of the Neuroscience-Neurovascular Intensive Care Unit (NNICU). This includes the access, acute evaluation and treatment of patients with hemorrhagic and ischemic stroke, and the coordination of subsequent therapeutic strategies including surgery, interventional neuroradiology, stereotactic radiation, and rehabilitation. The Program is an integral dimension of the Yale Cerebrovascular Center, which also includes the Vascular Neurology Program and the Interventional Neuroradiology Program. The clinical program is committed to providing facilitated access to specialized opinion and care within a horizontally integrated multidisciplinary framework incorporating the expertise of leading specialists in several medical and surgical specialties.
This is a model clinical service, unique in breadth and depth nationally. Clinical activities of this Program include a substantial volume of surgical activity and case complexity of neurovascular surgical procedures at Yale, representing a consolidation and expansion of teaching and research patient base in this area and the introduction of the latest techniques and modalities in the field, some of which are not available elsewhere in Connecticut. There is multidisciplinary coordination of patient access, a multispecialty outpatient clinic, and an integrated inpatient service. A weekly multidisciplinary patient management conference allows the discussion of care plans for individual cases and the development and review of clinical protocols within an open academic atmosphere. Collaborations are established with a number of services including Neurology, Radiology (diagnostic and interventional), Otolaryngology and the Skull Base team, Pediatric Neurosurgery, Stereotactic Radiosurgery, Epidemiology and Genetics, Rehabilitation, the Yale Vascular Center, and the Yale School of Nursing. There is close collaboration between the NNICU and the Section of Trauma and Critical Care of the Department of Surgery.
A faculty career development fellowship is provided for highly meritorious neurosurgeons with a promise of academic leadership allowing the launching of an academic career focused on neurovascular surgery and critical care within a structured programmatic environment. This unique program attracts applications from the brightest graduates of neurosurgical training programs nationally, and greatly enriches clinical, education and research programs at Yale.
Human tissue from resected surgical specimen is subjected to molecular dissection, exploring potential roles of structural and functional probes including angiogenesis factors in the genesis and clinical progression of hemorrhagic cerebrovascular lesions. These are correlated with prior lesion behavior, and are integrated into novel strategies of lesion classification, diagnosis and treatment.
A collaborative project with the Boyer Center for Molecular Medicine at Yale is aimed at localizing genes predisposing to familial cerebral aneurysms and vascular malformations, and molecular mechanisms predisposing to the inheritance and genesis of lesions causing hemorrhagic stroke. This collaboration includes more than ten regional and national neurosurgical centers contributing case material to this project within the scope of the Neurovascular Research Consortium based at Yale.
Other investigations are aimed at examining brain function in association with focal cerebrovascular lesions and mechanisms of functional recovery from stroke. A research study addresses the cerebrovascular manifestations of hereditary hemorrhagic telangiectasia, a rare familial disease of inherited dysvasculogenesis. Question-driven technology assessment is underway in a number of projects examining the role of novel diagnostic and treatment strategies. These include outcome evaluations of multidisciplinary therapeutic approach, and the role of surgical adjuncts including stereotactic radiosurgery and interventional neuroradiology.
The Yale Neurovascular Surgery Program can be reached at 203-737-2096
or email to issam.awad@yale.edu
Department of Neurosurgery address and phone number