The Complex Brain Surgery Program, under the direction of department chairman Robert Friedlander, MD, is devoted to the surgical treatment of lesions and tumors located in deep, eloquent or difficult-to-reach regions of the brain. The goal of the program is to provide gentle, accurate, and safe surgery for the most complex lesions and locations, often regarded as inaccessible or high-risk.
This program has its foundation on a precise and meticulous knowledge of microsurgical neuroanatomy and neurosurgical approaches, and is built upon extensive surgical experience at UPMC, and intense microsurgical learning and research conducted at the Surgical Neuroanatomy Lab and the Fiber Tractography Lab at the University of Pittsburgh.
Areas of surgical expertise include intrinsic tumors in eloquent brain areas and deep white matter, limbic/paralimbic tumors (insula, medial temporal lobe, cingulum), intraventricular and thalamic lesions, pineal and posterior tentorial incisura tumors, cerebellar and brainstem lesions.
A unique feature of this program is the application of sophisticated presurgical planning techniques, such as surgical simulation with crafted anatomical specimens and High-Definition Fiber Tractography (HDFT), to carefully develop the most effective and less invasive operative plan.
HDFT is an advanced MRI-based non-invasive imaging technique, pioneered by Dr. Friedlander, to study the three-dimensional structure of the fiber tracts of patients with intrinsic brain lesions. HDFT provides a superior presurgical evaluation of the fiber tracts for patients with complex brain lesions, including benign, low grade, and high grade tumors. The combination of HDFT with accurate neuroanatomical knowledge of the white matter tracts is the key to design the less invasive trajectory into a target lesion, and apply more effectively intraoperative electrical mapping techniques for maximal and safe tumor resection in eloquent cortical and subcortical regions.