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For
Physicians
Epilepsy
Surgery EPILEPSY SURGERY The Epilepsy Surgery Program is internationally recognized as a leader in innovativesurgery for intracerebral diseases associated with medically intractable epilepsy. This multidisciplinary program includes neurosurgery, neurology, neuropsychology, neuro-radiology and neuropathology with outpatient facilities, a six- bed epilepsy monitoring unit and a technologically-advanced operating suite. Patients worldwide are evaluated in phases in order to precisely determine concordance of electrophysiology, cognitive testing, history, physical and neurological examination with advanced imaging using MRI, SPECT and PET techniques. The state of the art operating room suite contains advanced digitized imaging, computerized stereotaxy and sophisticated electrophysiology in order to perform optimal, yet safe resections and to place intracranial electrodes for those patients who need invasive electrophysiological confirmation of an epileptogenic region. The Yale program has been instrumental in developing many of the currently widely accepted surgical procedures for epilepsy. CONTACT: Special
interests: NEUROVASCULAR SURGERY PROGRAM The Yale
Neurovascular Program is committed to clinical excellence, superlative
technical performance and innovation in diagnosis and therapy. The
Program is entrusted with all facets of management of stroke and cerebrovascular
disorders and the coordination of subsequent therapeutic strategies
including surgery, interventional neuroradiology, stereotactic radiation,
and rehabilitation. Among special services provided is the diagnosis and treatment of the following: * Aneurysms
and vascular malformations CONTACT: Special
interests and projects: PEDIATRIC NEUROSURGERY The services of the Pediatric Neurosurgery Program provide the breadth of neurosurgical care for infants, toddlers, school aged children, adolescents and young adults. The Program has developed endoscopic approaches for the removal of large intraventricular hemorrhages in the premature infant. These approaches avoid the need for shunts for hydrocephalus through the use of with endoscopic, intraventricular procedures. Children with malignancies of the central nervous system are cared for within the Pediatric Oncology Group and the Cancer Center with full access to multidisciplinary care. Children requiring care in the Epilepsy Surgery Program are jointly managed by pediatric neurosurgery and the epilepsy team. Craniosynostosis and other craniofacial anomalies are managed through a joint program with plastic surgery. Among special services provided by this program is the evaluation and treatment of the following: Tumors of
the nervous system CONTACT: CHARLES
C. DUNCAN, M.D.. DENNIS
SPENCER, M.D. NEURO-ONCOLOGY PROGRAM The Neuro-oncology Unit, as part of the Yale Cancer Center, provides comprehensive care for patients with brain tumors. The Yale program is the only multidisciplinary consortium dedicated to neuro-oncology in southern New England. The program has gained regional and national recognition through the multidisciplinary program that includes surgical treatment, neurophysiological monitoring, high resolution and image-guided stereotactic techniques, radiation oncology, brachyotherapy, stereotactic radiosurgery and medical oncology. The Neuro-oncology Unit also provides the services of a dedicated Clinical Coordinator to facilitate access, coordinate services and support patients and their families. In collaboration with the Section of Otolaryngology, Yale's program for the surgical treatment of skull base tumors and acoustic neuromas has grown into a nationally recognized practice. CONTACT: Special
interests: SPINE SURGERY The spine program is a relatively new division in the department of Neurosurgery, nearing the end of the second year since its inception. Spine surgery now makes up the majority of neurosurgical cases department wide. The program has been developed and expanded over the past two years and now has achieved facile expertise in the management of all spine disease from the occipital cervical junction down to the sacrum. The Neurosurgical Spine Service has grown beyond the previous standard role of decompressions and resection of lesions to one that also involves complex reconstruction of the spine. Management
of metastatic spinal tumors, degenerative spine diseases and disorders,
primary spinal and intra-axial tumors, and spinal trauma is the program's
primary focus. We have recently introduced three new techniques centered
on minimizing an invasive approach. Khalid Abbed, M.D. Special
interests and projects: . STEREOTACTIC RADIOSURGERY Stereotactic radiosurgery is defined as the delivery of a single, high dose of radiation through the intact skull to a small and critically located intracranial volume. The gamma knife contains 201 cobalt-60 sources of approximately 30 Curies each at the time of loading, placed in a hemispherical array in a heavily shielded unit. A collimator helmet focuses the radiation to a specific target point within the head with sub-millimeter positioning accuracy in such a fashion that a high dose of radiation is delivered to the target while sparing the surrounding tissue. Complex-shaped lesions are treated by combining collimators of different sizes with selected beam blocking and weighting using a sophisticated computer planning system. This ensures that tight conformation of the dose to the edge of the target volume is achieved such that each patient receives a "tailored" plan. Safety and Efficacy Unlike the linear accelerator, the gamma knife has few moving parts thereby eliminating many sources of inaccuracy and unreliability. Because the radiation fall off is very steep outside the target area, the surrounding brain receives little radiation thereby minimizing harmful side effects to neighboring critical structures. Many of the risks of open surgery are eliminated with gamma knife radiosurgery, making the procedure particularly useful in patients with advanced age or in those patients with other illnesses where conventional surgery would pose an unacceptably high risk. Finally, the efficacy and cost effectiveness of the gamma knife treatment have been proven in numerous studies when comparing it to the alternative, namely open surgery. Who
can benefit from this treatment? In addition, the gamma knife is being used as an investigational tool for certain forms of epilepsy and psychiatric disease. Patients referred to the Yale-New Haven Gamma Knife Center will be evaluated by a team of specialists with extensive experience, including neurosurgeons, radiation oncologists and neuroradiologists. Candidates for the procedure are selected for treatment only after a thorough review of all prior records and imaging studies. CONTACT: NEUROPSYCHOLOGICAL SERVICES Neuropsychological
services are integrated with all of Yale's neurosurgery programs, making
the comprehensive care available at Yale unique among neurosurgery
centers in the area. MICHAEL
WESTERVELD, Ph.D. Special
interests:
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