Neurosurgery
Neuro-vascular Surgery
Endovascular Surgery
UMMC STROKE TREATMENT AND PREVENTION GROUP
Cerebrovascular Group Faculty Gurmeet S. Dhillon
|
Cerebrovascular
Group Affiliates Marie Acierno, M.D. James J. Corbett, M.D. Neurology Ruth K. Fredericks, M.D. Neuro ICU Ahmed Badr, M.D. Dale Hoekema, M.D. |
Neurovascular (Stroke) Group
Appointments:
(601)-984-5700
Emergency:
1-888-UMC-2345
THE UMMC NEUROVASCULAR (STROKE) GROUP
A multidisciplinary team provides stroke patients, and those at risk for stroke, with a continuum of services, including screening, diagnosis, treatment, prevention and rehabilitation of a wide range of circulatory disorders involving the brain and spinal cord. The Group is equipped with state-of-the-art technology to address all major categories of stroke, including atherothrombotic brain infarction, embolic brain infarction, transient ischemic attacks, intracerebral hemorrhage, and subarachnoid hemorrhage due to aneurysms and vascular malformations.
The Group has the capability of diagnosing and treating aneurysms and arteriovenous malformations (AVMs), important causes of stroke which are now readily treatable. University of Mississippi medical staff are involved in the latest advances in stroke management, including TPA for atherothrombotic strokes, platinum coils for aneurysms, embolization and stereotactic radiosurgery for AVMs. Additionally, the Group is intimately involved in treating traumatic brain and spinal cord injury, which share some clinical and pathological features with stroke.
A critical advantage of UMC's medical staff comprehensive approach is the experience and skill developed from the diagnosis and treatment of a large number of patients with complex cerebrovascular conditions. The Stroke Group has an ongoing commitment to research for safer and less invasive stroke treatments, and remains an active participant in basic science research and clinical trials for new drugs.
Focus on Early Intervention
The aircare program, a 24-hour emergency air transport is available to ensure that the appropriate diagnostic and therapeutic interventions can be instituted in less than six hours of symptom onset for optimum results. Phone Number: 1-888-UMC-2345.
DIAGNOSTIC SERVICES
In keeping with the focus on early intervention, the UMC Neurovascular (Stroke ) Group's diagnostic facilities are focused on early recognition using the most up-to-date imaging modalities.
The following imaging modalities
are available:
Computed Tomography (CT) is often used to quickly distinguish between
a hemorrhagic and ischemic stroke. This is critical when planning early
intervention. Rapid spiral scanning is available at UMC to obtain extremely
rapid studies. The Medical Center maintains two state-of-the-art CT scanners
and is in the process of adding a third machine. The new CT angiography
technology is also in use.
Magnetic Resonance Imaging (MRI) is a useful study for precisely
locating the stroke and determining the extent of the ischemic or hemorrhagic
stroke. It also allows for precise delineation of a variety of pathologic
lessons in the brain and spinal cord that can lead to stroke.
Magnetic Resonance Angiography/Venography
(MRA/MRV) is a non-invasive imaging technology for visualization
of cerebral vasculature. It also allows measurement of flow in major intracranial
and extracranial vessels.
Duplex Doppler Scanning of the Carotid Artery is an ultrasound
imaging technique that helps to determine with high sensitivity and high
specificity whether extracranial arteries are narrowed or occluded and
at risk of causing stroke.
Transcranial Doppler (TCD) is another ultrasound procedure that
allows for assessment of blood flow velocity through the intracranial
vessels (e.g., middle cerebral artery) This is also a very useful technique
for detecting vasospasm in patients who have suffered a subarachnoid hemorrhage,
embolism, or carotid dissection. Because the TCD unit is portable, the
test may be performed at the patient's bedside.
Cerebral Angiography
remains the gold standard for diagnosis of arterial occlusions,
stenoses, arterial dissections, aneurysms, AVMs, and other vascular abnormalities.
Other Diagnostic Services:
Radionuclide SPECT Scanning provides data on relative blood flow
using the radionuclide Technetium-99. The procedure is well tolerated
by most patients. This test may be also utilized in conjunction with balloon
test occlusion of the internal carotid artery for the management of complex
vascular lesions.
Interventional Magnetic Resonance
Imaging (IMRI) The University of Mississippi Medical Center has
been a leader in developing the neurosurgical applications of IMRI technology
including its use in the management of complex vascular disorders. IMRI
provides information regarding the anatomy of the brain and cerebral vessels
to the surgeon in virtual real-time.
Hematologic Evaluation Services UMC's comprehensive screening
services include testing for hematologic abnormalities including problems
with excessive clotting, or those related to abnormal bleeding. Screening
is provided for hematologic risk factors such as hyperlipidemia, anticardiolipin
antibodies and hypercoagulable states which are associated with stroke.
Cardiac Evaluation Services Approximately twenty percent of strokes
are due to cardiogenic causes such as atrial fibrillation, myocardial
infarction and valvular abnormalities. UMC offers modern cardiac evaluation
modalities including transesophageal echocardiography.
Neuro-ophthalmology Services--A significant number of patients
who suffer a stroke experience visual impairment. The University of Mississippi
Medical Center offers a comprehensive neuro-ophthalmologic evaluation
as part of the UMC Stroke Group.
THERAPEUTIC SERVICES
The UMC Neurovascular (Stroke) Group offers a complete array of therapeutic
services including advanced surgical techniques, Guglielmi detachable
coils (GDC), circulatory arrest, stereotactic guidance, electrophysiologic
monitoring, and access to the newest medications for neuronal and cerebral
protection.
The Group emphasizes an interdisciplinary approach to the management of
stroke patients. Various specialties apply their expertise to determine
the ideal approach for each patient. An interdisciplinary neurovascular
conference is held regularly to help achieve our goal of providing the
best treatment available for each patient. The Group provides the following
therapeutic services:
Endovascular Techniques
The Neurovascular (Stroke) Group has at its disposal several endovascular
procedures for patients with AVMs or aneurysms. These minimally invasive
procedures, which do not require an incision, are generally better tolerated
than conventional surgery.
Endovascular Treatment of Aneurysms is currently the preferred
modality for most patients harboring these lesions. GDC coils can be guided
into an aneurysm via a catheter, creating a clot that effectively closes
the aneurysm off from the surrounding circulation. Trapping or proximal
balloon occlusion is another form of treatment used to block the artery
leading to the aneurysm, thereby causing the aneurysm to thrombose.
Endovascular Treatment of AVMs and fistulae--UMC's neuro interventionalists
are involved in the endovascular treatment of AVMs and fistulae as well.
This involves the use of a type of "glue" or coils, introduced via a tiny
catheter, to block off abnormal blood vessels. These procedures often
reduce the size of the AVMs, allowing the use of stereotactic radiation
and microsurgery. Furthermore, they can be curative for a variety of other
vascular malformations.
Extracranial angioplasty and stenting: This minimally invasive
way of treating narrowed blood vessels in the neck that are at risk for
causing stroke is gradually gaining acceptance. Currently, we reserve
these procedures for patients whose disease is not amenable to surgical
treatment or those who strongly prefer a minimally invasive approach.
Cerebral Angioplasty and Intra-arterial Thrombolysis are new therapeutic
procedures. These techniques are also performed endovascularly and are
similar to those current done on the heart. Silicone microballoon systems
are now capable of dilating small intracranial arteries. Stents are being
developed to maintain lumen diameter in the cerebral circulation, also.
Angioplasty Treatment of Vasospasm involves physically dilating
a blood vessel affected by subarachnoid hemorrhage induced vasospasm.
Transluminal angioplasty is frequently used in conjunction with intra-arterial
papaverine to reverse vasospasm.
Surgical Techniques
Carotid Endarterectomy is often performed under local anesthesia,
which reduces the complications. The excellent surgical results of the
Group, past and present, have been published in peer-reviewed journals.
Microsurgery is a treatment modality available at UMC for the treatment
of aneurysms and AVMs. The binocular magnification and excellent lighting
provided by the operative microscope makes these delicate operations much
safer. For deep-seated lesions, stereotactic techniques which rely on
sophisticated computer technology and uses geometric principles to precisely
localize the coordinates of the AVM are used. Using three dimensional
reference points, targets are established that enable the neurosurgeon
to access the previously plotted area with a precision of a few millimeters
without disrupting normal brain tissue. Interventional MRI is the next
generation of stereotactic guidance. This technology will not only ensure
precise localization, but also ensure complete removal of AVMs and cavernous
malformations.
Hypothermia is a neuroprotective tactic that provides the surgeon
with the necessary time to treat complex AVMs and aneurysms. Recently
researchers have discovered that dropping brain temperature to just 32°
C (mild hypothermia) still resulted in significant protection against
intraoperative stroke. This knowledge is now routinely used for cerebrovascular
surgery, in combination with circulatory arrest of the area surrounding
the aneurysm or AVM.
Revascularization of the Brain Blood Supply is a technique for
treating an aneurysm or occluded cerebral artery that provides a bypass
route for blood to the brain by grafting the saphenous vein or a scalp
artery to a cerebral artery. After obliterating the aneurysm, or in the
presence of an occluded artery, the graft is placed to revascularize the
brain area. Moyamoya disease, an occlusive cerebral arterial vasculopathy
that often affects children and young adults, and giant aneurysms can
be addressed with these brain revascularization techniques.
Stereotactic Radiation Techniques
Stereotactic radiosurgery is a minimally invasive technology which shrinks
away certain small, well circumscribed tumors and arteriovenous malformations
within the brain. The technique is often used on deep seated AVMs that
are not amenable to surgical treatment.
Gamma Knife Radiosurgery utilizes non-invasive photon beams to
radiate an AVM with low risk to the surrounding normal brain. The procedure
lasts approximately 30 minutes, and usually results in gradual narrowing
of the blood vessel walls. Most AVMs become obliterated within two years
of radiosurgery.
Intensive Care
The neuro intensive care unit is staffed by two critical care physicians.
The twenty bed facility in the new UMC critical care tower has state-of-the-art
equipment for monitoring and treating patients requiring intensive care.
Rehabilitation Services
The most up-to-date rehabilitation services for stroke patients are provided
at the largest and most specialized rehabilitation center in the state,
Mississippi Methodist Rehabilitation Center, which is immediately adjacent
to the University of Mississippi Medical Center. MMRC's approach is comprehensive.
The rehabilitation program includes everything from inpatient services
to outpatient treatment to follow-up and home health services. Over the
past 20 years, they have treated more than 10,000 stroke patients.
Emergency Department Services
University of Mississippi Medical Center is the major Trauma Center for
Mississippi, offering state-of-the-art emergency services and communications
systems. UMC offers 24-hour emergency helicopter transport through its
aircare program. The emergency department staff provides an early and
essential communications link in the identification and treatment of stroke
patients. Phone Number: 1-888-UMC-2345.
Multidisciplinary Team Approach
The case management system at UMC offers the benefits of multidisciplinary
rounds including the expertise of neurosurgeons, interventional neuroradiologists,
neurologists, clinical nurse specialists, social workers, physical and
occupational therapists, pharmacists and dieticians providing comprehensive
patient care. The UMC Neurovascular Group interfaces with the Department
of Social Services and Utilization Management to provide comprehensive
patient and family advocacy and support services.
The Referring Physician
The referring physician is an active partner in the treatment process.
Each patient's case is reviewed by the multidisciplinary team and all
treatment, follow-up, progress and patient outcome studies are done in
conjunction with the patient's referring physician.
University of Mississippi Cerebrovascular Group Principals
- Gurmeet S. Dhillon, M.D.
Neuroradiology, UMC Stroke Group
Dr. Dhillon is assistant professor of radiology at The University of Mississippi School of Medicine. He received his medical degree from The University of Western Ontario. Following training in radiology at Queen's University, he trained in neuroradiology at the Universities of Toronto and Florida. He came to UMMC after working in Philadelphia. His main interests are diagnostic imaging and treatment of neurovascular disorders. He is also involved in the interventional MRI group.
- Rahul Vohra, M.D.
Director, Stroke Rehabilitation Center, UMC Stroke Group
Dr. Vohra is director of the Stroke Rehabilitation Unit at the Mississippi Methodist Rehabilitation Center. He earned the bachelor degree and the M.D. at Baylor University. He completed a residency in Internal Medicine at the University of Texas Medical Branch in Houston, Texas and a fellowship in physical medicine and rehabilitation at Baylor University.
For more information or referrals, contact:
The University of Mississippi Medical Center
Department of Neurosurgery
2500 North State Street
Jackson, MS 39216-4505
TEL (601) 984-5700
FAX (601) 984-5733