Image-Guided Outcomes

Since the establishment of the Center for Image-Guided Neurosurgery at UPMC in 1981, various surgeons have focused on improving outcomes in patients with brain disorders by application of minimally invasive techniques using stereotactic guidance technologies. More than 20,000 patients have undergone surgical procedures that include diagnostic and therapeutic brain procedures (approximately 7,000 patients) and stereotactic radiosurgery using the Leksell Gamma Knife®. As a center committed to clinical outcomes research as well as advancing patient outcomes, we have published more than 500 peer reviewed articles, book chapters, and three books. Highlights of our activities are included below.

Stereotactic Operative Procedures

In our publication in Stereotactic and Functional Neurosurgery, we established a benchmark for risks associated with stereotactic frame based diagnostic and therapeutic procedures. We defined the role of such techniques in the management of a wide variety of brain tumors, brain cysts, craniophayngiomas, brain abscess, and colloid cysts of the third ventricle.

Figure 1

Stereotactic Radiosurgery Procedures

Vascular Malformations
With one of the largest worldwide experiences in the use and assessment of radiosurgery for AVMs, we have published extensively on outcomes in AVM patients with Spetzler Martin Grades of all types. We have studied outcomes associated with the use of repeat radiosurgery, the influence of associated aneurysms, and the results of treatment of pediatric, Sylvian, visual pathway, basal ganglia, brainstem, and thalamic AVMS. We have also reported the outcomes of patients with cavernous malformations and dural AV fistulas.

Figure 2

Figure 3

Brain Tumors
Our experience and publications relate to the wide role of Gamma knife Radiosurgery in metastatic tumors, skull base tumors, primary glial tumors, hemangioblastoma, hemangiomas, meningiomas, chordomas, chondrosarcomas, and pituitary tumors. We have emphasized both tumor control rates and complication detection and avoidance.

Figure 4

Figure 5

Figure 6

Functional Neurosurgery (Pain and Movement Disorders)
During this 33-year interval, we have performed minimally invasive management of trigeminal neuralgia using both percutaneous techniques (> 1200 glycerol rhizotomies and >1200 Gamma knife procedures 27,47-56). Using such techniques one or more times allows us to effectively treat medically and surgically refractory facial pain with the goal of pain control (70-80% of patients) and maintain low morbidity.

Figure 7

Movement disorder surgery using radiofrequency ablative procedures such as thalamotomy 57-60 or pallidotomy have been applied in patients with Parkinsons Disease and Essential Tremor. Gamma knife thalamotomy has been associated with 70-80% of patients have excellent tremor suppression without the need for brain electrode implantation.

Figure 8