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Neurosurgery

Cerebrovascular and Endovascular Surgery

The Neurovascular Surgery Program at Tufts Medical Center in Boston, MA provides world-class minimally invasive surgical, endovascular, and radiosurgical treatment for diseases that occur in the blood vessels that supply the brain and spinal cord with oxygen and nutrients.

The most common conditions that affect these blood vessels are:

  • Aneurysms
  • Arteriovenous Malformations (AVMs)
  • Dural Arteriovenous Fistulas
  • Carotid and Vertebral Artery Disease
  • Carotid and Vertebral Occlusive Disease
  • Cavernous Malformations
  • Cerebral Aneurysms and Subarachnoid Hemorrhage
  • Spinal Dural Arteriovenous Fistulas (DAVF)
  • Moyamoya Disease
  • Stroke
  • Vascular Malformations and Hemangiomas
  • Vasculitis
  • Venous Malformations

An expert neurovascular surgery team right in Boston

Adel Malek, MD is a neurosurgeon at Tufts Medical Center.If you or a loved one has an aneurysm or other neurovascular condition, you want to see the best possible neurosurgery team you can find. Well, you’ve found it; right here in Boston. We are one of the busiest neurovascular surgery programs in New England.

One of the reasons we see so many patients in our Neurovascular Surgery Program is that primary care and other referring physicians know that we offer the full range of treatment options available, including the latest minimally invasive approaches (see below).

Our program is also well-respected because it includes a multidisciplinary team lead by a true expert in neurovascular surgery techniques. Chief of Neurovascular Surgery at Tufts MC, Adel Malek, MD, PhD, is well known for his expertise in the multi-modal and minimally invasive treatment of aneurysms, brain arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs).  He is board certified, completed neurosurgical training at Brigham and Women’s/Children’s Hospital Boston and his neurointerventional radiology fellowship at the University of California, San Francisco. Dr, Malek is director of the Cerebrovascular and Endovascular division in the Department of Neurosurgery, and is one of the earliest adopters of minimally invasive endovascular approaches for treatment of brain aneurysms and subarachnoid hemorrhage.

Common neurovascular surgical approaches

Our Neurovascular Surgery Program offers the latest microsurgical, endovascular and radiosurgical techniques, sometimes in combination, to provide our patients with the best possible therapy for their unique condition. Below are short descriptions of some of the most common procedures available. If you have any questions, please don’t hesitate to call us at 617-636-8200.

Aneurysm Treatments
A brain aneurysm is a weak spot in the wall of an artery in the brain. It’s a bit like a thin balloon. Blood flowing over the weak spot can cause wear and tear on the artery. Eventually, that can cause the artery wall to rupture, or tear, allowing blood to escape into the brain itself.

Coiling – One of the most common ways we treat aneurysms is by using a minimally invasive treatment called coiling. The neurosurgeon inserts catheters into a vessel over the femoral artery going to the leg and navigates through the blood stream to the blood vessels in the brain. Coils are then gently inserted into the aneurysm until it is completely packed and isolated from the parent vessel, preventing blood from flowing into it and protecting it from rupture.

Microsurgical clipping – Also known as ”clipping” or “open surgical clipping,” this procedure is used to treat aneurysms by making a small incision in the skin on the head to make an opening in the skull. The surgeon then uses a microscope to find the impacted blood vessel and place a clip across the aneurysm, preventing blood from flowing into it and protecting the patient from the risk of aneurysm rupture. 

Stent assisted coiling –This is a more advanced form of endovascular treatment which is needed for treating certain wide-necked brain aneurysms. During this procedure, the neurosurgeon will place a stent in the vessel adjacent to the aneurysm to support the coils within the aneurysm and enable protection from rupture.

Flow diversion – Flow diverting embolization devices are finely meshed stents placed in the main vessel harboring the aneurysm to divert flow away from the aneurysm, and allow the vessel wall to heal by forming a new lining.

Stroke Treatments
A stroke occurs when blood supply to the brain is cut off or there is bleeding in the brain. Within minutes of this happening, brain cells begin to die. It is important to immediately call for emergency care at the first sign of a stroke. After receiving emergency care, some stroke patients may be referred for surgery.

Angioplasty – This procedure is used when a stroke is caused by a narrowing of the arteries in the brain due to a harmful fatty deposit called plaque. During an angioplasty, the neurosurgeon uses a tiny balloon at the end of a thin tube to push through the artery to the blockage and open the artery. A mesh tube called a stent may be used to hold the artery open for the long-term.

Endarterectomy – This procedure is used when a stroke occurs in the carotid arteries (the arteries in the neck that supply the brain with blood). During this procedure, the surgeon opens the narrowed artery and carefully cleans the plaque away, restoring flow and preventing further stroke.

Bypass surgery – This technique is used in some cases to provide a new pathway for blood flow to supplement whittled brain vessels such as in Moya Moya condition or to get around a very large aneurysm. During a bypass surgery, the surgeon re-routes the artery on the outside of the scalp to the part of the brain that is not getting enough blood flow.

Vascular Malformations and Other Neurovascular Condition Treatments

Non-invasive Stereotactic Radiosurgery via The Gamma Knife – Tufts MC’s Department of Neurosurgery is home to the only Gamma Knife Center in Massachusetts and Northern New England. This unit offers a safe, painless alternative for treating brain arteriovenous malformations (among other conditions) by using extremely accurate beams of radiation to shrink the AVM while sparing normal adjacent brain tissue. Learn about our Gamma Knife Center >

Microsurgical resection – This treatment is used in certain cases where the AVM or fistula can be safely removed without affecting brain function and where the AVM may have ruptured with an associated blood clot. During the procedure, the neurosurgeon will perform a craniotomy (surgical removal of part of the skull bone to expose the brain) and disconnect and remove the AVM or fistula from the surrounding tissues around the brain.

Endovascular embolization – During this procedure, a catheter is used to place a synthetic material into the blood vessel to block blood flow to a specific part of an artery. This approach is often used for treating cerebral AVMs and DAVFs, and can be used in tandem with microsurgical resection and stereotactic radiosurgery like the Gamma Knife.

We are able to provide these less-invasive surgical options because we use advanced technologies for neuro-imaging, surgical navigation and brain monitoring that allow our surgeons to accurately target and treat neurovascular diseases.  

Our team is constantly trying to find new ways to accurately diagnose and treat patients with neurovascular conditions so that they get the best possible outcomes. We offer clinical trials that provide access to some of the latest treatment options available.

We’re also performing in-depth research focused on the cellular biology and mechanotransduction involved in the development of brain aneurysms and AVMs.

Catching brain aneurysms before they happen

Most brain aneurysms have no symptoms, so people don’t usually realize that they have one. Often, determining whether an aneurysm will rupture has been a matter of reviewing family history. If you have two or more family members who have had aneurysms, a physician will monitor you for aneurysms, and provide you with needed elective preventative treatment.

Many aneurysms are also found incidentally when patients undergo MRIs or CT scans. When one is detected, physicians need to decide how likely the aneurysm is to rupture: Should the aneurysm simply be monitored, or does it need to be treated?

That’s why Dr. Malek and his team are working on a way to predict possible aneurysm rupture using an aerospace engineering technique called computational fluid dynamics. Although this technique was initially developed to study airflow over wings, we are able to use it to look at how blood flows through the brain’s blood vessels and derive some of the features that predict its level of danger. We’re learning that blood flow may be different in patients with aneurysms compared with patients without aneurysms.

By taking images of a patient’s brain, we’re able to generate a 3-D computer model of the brain’s blood vessels. Using fluid dynamic equations and sophisticated computer techniques, we can then simulate the blood flow through those vessels to analyze the blood’s speed and direction, and the force it exerts on the vessel wall. This allows us to predict whether the blood flow has a concerning pattern that could lead to aneurysm rupture and better determine whether the aneurysm needs to be treated.

Carl B. Heilman, MD

Carl B. Heilman, MD

Title(s): Neurosurgeon-in-Chief; Chairman of Neurosurgery; Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-5860
Fax #: 617-636-7587

Meningiomas, acoustic neuromas, skull base surgery, pituitary surgery, Chiari surgery

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Joshua Kornbluth, MD

Joshua Kornbluth, MD

Title(s): Medical Director, Neurosciences Critical Care Unit; Program Director, Neurology Residency and Neurocritical Care Fellowship; Neurologist; Assistant Professor, Tufts University School of Medicine
Department(s): Neurology
Appt. Phone: 617-636-4948
Fax #: 617-636-8199

Neurocritical care

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James Kryzanski, MD

James Kryzanski, MD

Title(s): Chief, Division of Epilepsy Surgery; Co-Chief, Division of Spinal Surgery; Assistant Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-8585
Fax #: 617-636-7587

Epilepsy neurosurgery, skull base surgery, pituitary surgery, neurovascular surgery, minimally invasive spine surgery, neurosurgical disorders in patients with achondroplasia, neurosurgical disorders in patients with Down syndrome

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Adel M. Malek, MD, PhD

Adel M. Malek, MD, PhD

Title(s): Chief, Division of Neurovascular Surgery; Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-8200
Fax #: 617-636-7587

Aneurysms, arteriovenous malformations, dural fistulas, subarachnoid hemorrhage, intracranial atherosclerosis, arterial dissection

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Julian K. Wu, MD

Julian K. Wu, MD

Title(s): Associate Chairman, Department of Neurosurgery; Chief, Division of Neurosurgical Oncology; Neurosurgery Residency Program Director; Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-4500
Fax #: 617-636-7587

Neuro-oncology, Gamma Knife radiosurgery, meningiomas, pituitary tumors, gliomas, brain metastasis, trigeminal neuralgia

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