Our Program

The USC Neurovascular Disorder Center at Keck Medical Center of USC in Los Angeles takes an interdisciplinary approach to treating a range of blood flow disorders in the central nervous system, including stroke, arteriovenous malformations, carotid artery stenosis and aneurysm. The center is led by neurosurgical experts who have some of the most extensive experience in the operative management of these and other disorders. Our endovascular neurosurgeons perform embolizations, angioplasty and stent placements. We are also staffed with interventional neuroradiologists, who form an integral part of the neurovascular team.

Our Approach

The USC Neurovascular Disorder Center is a multidisciplinary program for patients and their referring physicians. The center is set up as a “one-stop shop” for patients with neurovascular disorders who need treatment. Physicians from a number of disciplines can treat patients at the same time or location.

Our team is skilled in a variety of complex surgical procedures in the treatment of these disorders, including stroke, aneurysms and arteriovenous malformations. Other techniques have been and continue to be developed at USC to deal with special cases.

Conditions

The USC Neurovascular Disorder Center diagnoses and develops treatments for a wide range of disorders caused by impaired blood flow in the brain. These disorders can be caused by vascular blockages, excessive bleeding, structural malformations, inflammation and other problems. Some of the many neurovascular disorders treated at the USC Neurovascular Disorder Center include:

Ischemic stroke – a sudden blockage of normal blood vessels to the brain. The brain tissue does not receive adequate blood supply and oxygen, which causes permanent weakness to the tissue until the blockage is removed. For more detailed information about stroke, click here.

Brain aneurysm – a weakness in a blood vessel (usually an artery), which causes the vessel to enlarge in size and eventually rupture. For more detailed information about brain aneurysm, click here.

Arteriovenous malformation – usually a genetic anomaly which is discovered at birth in the brain’s blood vessels. They are high-flow tangles of blood vessels that are formed before or near birth. The natural transition between high flow arteries and low flow veins called capillaries are missing. The result is a large tangle of thin-walled blood vessels with very fast flowing blood coursing through the ‘nidus’ or nest. For more detailed information about arteriovenous malformation, click here.

Cavernous malformation – another type of blood vessel abnormality, which can bleed, causing strokes and seizures. Cavernous angiomas, also known as cavernous hemangiomas, cavernous malformations or cavernomas, are well-circumscribed, benign vascular lesions composed of thin-walled irregular caverns without intervening neurological tissue. These lesions differ from arteriovenous malformations in that they do not have large feeding arteries or large draining veins, and their endothelium lining lacks typical smooth muscle. The vessel walls of the cavernous angiomas may hemorrhage, create a clot or calcify.

Carotid stenosis – narrowing of blood flow through the carotid artery, the main source of blood flow to the brain. This reduction of blood flow can cause strokes or TIAs (“mini-strokes”). For more detailed information about carotid stenosis, click here.

MoyaMoya disease – a rare, genetically acquired inflammation of blood vessels in the brain, which can bleed or cause strokes. The disorder, which progressively impairs more blood vessels over time, is most prevalent among Asians and Americans of Asian descent.

Treatments

New patients are interviewed at a Monday morning center clinic by three or four people simultaneously. At these clinics, every one of the disciplines in USC Neurosciences at Keck Medicine of USC is represented.

The center’s interdisciplinary team offers a wide range of treatments for neurovascular disorders. These treatments could be surgical, involve radiotherapy or medical/chemical treatments (for example, embolization) or utilize radiosurgery, such as the Gamma Knife®.

Treatment for stroke and carotid stenosis

Carotid therapies
One method for relieving obstruction of blood flow in the carotid arteries is to surgically remove the fatty deposits causing the blockage. This operation is known as a carotid endarterectomy. An alternative to carotid endarterectomy is balloon angioplasty of the narrowed portion of the carotid artery. In this procedure, a plastic tube or catheter with a balloon is advanced over a guide wire to the site of narrowing. The balloon is inflated, widening the flow channel. A metallic stent may be left in place afterward to keep the artery open.

Thrombolytic therapy
A method for removing a blood clot obstructing a brain artery is to advance a tiny tube or catheter through the affected blood vessel to the site of obstruction. Through this catheter, a “clot busting’ medicine (thrombolytic agent) can dissolve the clot. Once the blockage is relieved and normal blood flow is restored, brain damage may reverse. To be effective, however, this form of therapy needs to be instituted within six hours of the onset of stroke symptoms.

Treatment for brain aneurysm

Aneurysms may present without any symptoms. Occasionally they are discovered “accidentally” when a CAT scan or MRI scan is performed for another reason. If symptoms present, they may include extremely severe headaches with loss of consciousness, seizure, double vision, progressive blindness in one eye or numbness on one side of the face.

An aneurysm of a brain artery may be treated by surgically placing a metal clip on the outside of the aneurysm, thus stopping blood flow to it. This prevents future bleeding from the aneurysm. In selected cases, an alternative treatment is coil embolization of the aneurysm. In this procedure, a tiny tube or catheter is advanced through a brain artery and is then inserted directly into the aneurysm. In this location, multiple soft platinum coils are deposited within the aneurysm, stopping the flow to it.

Treatment for arteriovenous malformation

To diagnose an anteriovenous malformation (AVM), a CAT scan will show evidence of any hemorrhage, but may not show the malformation itself. An MRI frequently shows evidence of enlarged or misshapen vessels, suggesting the presence of an AVM. Symptomatic patients or those with a high degree of suspicion for a brain or spinal cord AVM undergo a catheter angiogram, where dye is injected into the brain or spinal cord blood vessels and rapid fire pictures are taken.

Some AVM symptoms can be treated without treating the AVM itself. Headaches can be relieved with pain medicines. Seizures associated with AVMs are treated with antiepileptic drugs. It is only when these medicines fail to stop or control the seizures that definitive treatment of the AVM is warranted.

AVM Surgery
The obliteration of small brain AVMs can be accomplished in two ways:

  • A surgical procedure done under the operating microscope whereby the malformation of blood vessels is removed. In most instances this procedure stops such symptoms as seizures and reduces the chance of bleeding.
  • Radiation can be applied to the AVM as an outpatient using the Gamma Knife® or CyberKnife® devices. Over time this treatment is associated with disappearance of the AVM between 65 percent to 85 percent of the time.

Treatment for cavernous malformations/angiomas

Cavernous angiomas are diagnosed by MRI scans. Treatment will depend on the type of malformation.

Asymptomatic lesions
In general, lesions that are asymptomatic and incidentally discovered are typically followed with MRI scans yearly for two years, then every five years thereafter. An MRI should be performed sooner if there is any clinical evidence of hemorrhage or new symptoms. Your physician may or may not decide to give you anti-convulsant medications.

Symptomatic lesions

  • Seizure – It is important to achieve complete seizure control with medication. Surgery for resecting the lesion may be indicated If your seizures are uncontrollable with multiple medications, your cavernous angioma is in a low risk and easily accessible area of the brain and your neurologist has concluded that the lesion is causing the seizure, If your seizures are controlled with medication, there may not be a compelling reason to have surgery. Epilepsy alone is not an indication for surgical resection.
  • Hemorrhage – If you have experienced one clinically relevant hemorrhage and your lesion is in a low risk, easily accessible area, surgical removal may be indicated. For lesions in higher-risk areas of the brain, surgical removal should be contemplated following the second clinically relevant hemorrhage. We have found that those patients who had a second clinically relevant hemorrhage were more likely to have a third hemorrhage, and neurological deficits from the third hemorrhage were much more significant compared to the first hemorrhage.
  • Progressive neurological deficit – surgical removal is probably indicated. However, your specific neurological deficits will most likely be worse after surgery. Chances are good that with time and therapy you will return to your condition at time of surgery, and may even improve further. Always remember that there are no guarantees. We encourage patients to discuss individual results and outcomes with their physicians.

Treatment for MoyaMoya disease

A computed tomography (CT), computed tomography angiography (CTA) or Magnetic Resonance Imaging (MRI) scan show details of inner structures of the brain and may help identify inflammation of the blood vessels. In addition, ultrasound can measure impairment of blood flow.

Sometimes, aspirin can reduce the risk of blood clotting and halt the progression of MoyaMoya disease. If this course is ineffective, then surgery is indicated.

Neurovascular bypass surgery
With this technique, the surgeon stitches blood vessels in the scalp to blood vessels in the brain. Using microsurgery, neurosurgeons often suture the superficial temporal artery (which sits on the side of the head) to the middle cerebral artery (which supplies blood directly to the brain).

Our Physicians

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Practicing Locations

Keck Hospital of USC
LAC+USC Medical Center
USC Healthcare Center 2
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Practicing Locations

USC Healthcare Center 2

Specializing In

Cerebrovascular Disease of the Brain and Spinal Cord, Surgical Approaches to the Cranial Base, Stereotactic Radiosurgery, Microvascular Decompression for Bell’s Palsy, Lateral Skull Base Surgery for Facial Nerve Tumors

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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 2
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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 2
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Practicing Locations

Keck Hospital of USC
LAC+USC Medical Center
Other Locations
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