Center for Image-Guided Neurosurgery

The Center for Image-Guided Neurosurgery (CIGNS) led by L. Dade Lunsford, MD, Lars Leksell Distinguished Professor at the University of Pittsburgh, incorporates the expertise of individuals in image-guided stereotactic and functional neurosurgery, brain tumor surgery, Gamma Knife radiosurgery, neuro-oncology, radiation oncology and neuro-radiology. Ajay Niranjan, MD, MBA, is associate director of the center. The goal of the center is to provide quality patient care using minimal access or minimally invasive stereotactic and radiosurgical technology, high resolution neuroimaging and advanced computer systems. In 1981, the center was the first U.S. center to install a dedicated computed tomography (CT) scanner in a unique stereotactic operating room suite. 

As the first North American group to initiate a clinical program for Gamma Knife stereotactic radiosurgery in 1987, the Center for Image-Guided Neurosurgery continues to be a leader in this field. Currently, two Gamma Knife units are located at UPMC Presbyterian, one of the few clinical sites in the world with two clinical units. In the fall of 2007, the Leksell Gamma Knife Perfexion™ was installed. This fifth generation Gamma Knife unit incorporates advanced robotics, expands the role of radiosurgery to include extracranial targets, provides greater patient access, and enhances patient safety. In 2016, UPMC installed its sixth Gamma Knife, the newest generation ICON Gamma Knife. It was reenergized with new Cobalt 60 sources in May of 2021. The ICON incorporates a cone beam CT imaging system with the Gamma Knife in order to facilitate a mask stereotactic fixation system for selected patients.

Gamma Knife technology represents one of the most advanced means available to help patients with brain tumors, arteriovenous malformations (AVMs), and pain or movement disorders. Over 17,000 patients have undergone Gamma Knife stereotactic radiosurgery at UPMC Presbyterian. In addition, spinal radiosurgery using several radiosurgical systems is offered under the direction of Peter Gerszten, MD, who serves as the Peter E. Sheptak Endowed Professor at the University of Pittsburgh.

The center also has a dedicated MEGIN NeuroMag® magnetoencephalography (MEG) unit that performs brain mapping in patients with structural brain lesions, epilepsy, trauma and degenerative brain disorders. Dr. Niranjan is the operations director of the MEG project and continues to pursue cutting edge MEG research combining high-definition fiber tractography (HDFT) in the care of patients with refractory movement disorders and trigeminal neuralgia. UPMC’s MEG unit will be replaced by a state-of-the-art MEGIN TRUIXTM neo unit. This unit includes a helium recycling device to significantly reduce the annual cost of helium replacement needed to supercool the detectors of tiny brain waves that can allow detection of critical areas of brain function and the source of epileptic seizures.

The Center for Image-Guided Neurosurgery is also an international training site for radiosurgery and minimally invasive neurosurgery, holding six week-long training courses per year. Over the last 20 years, more than 2,500 neurosurgeons, neurootologists, radiation oncologists, medical physicists, and nurses have trained at this center. These courses are among the highest rated post-graduate courses offered at the University of Pittsburgh. In 2015, the center opened a new state-of-the-art education and training facility equipped with the latest generation high-definition display systems. In July of 2020, the center switched to virtual Gamma Knife training courses with participants from around the world attending remotely as “temporary” students at the University of Pittsburgh. Students can now remotely study radiosurgery effectively, avoiding the costs and time involved with national or international travel. CIGNS also participates in the training of selected fellows who compete for the Leksell Gamma Knife Society three-month fellowship in Pittsburgh. Neurosurgery residents at UPMC spend a three-month dedicated block for study during their third year of training. 

In addition, the center conducts numerous clinical, long-term outcome research projects and is the coordinating center for the International Radiosurgery Research Foundation (IRRF), a multi-institutional international clinical consortium of centers of excellence performing stereotactic radiosurgery. The IRRF currently has members from the United States, Canada, China, the Czech Republic, Spain, Taiwan, Egypt, Turkey and India. Multiple retrospective clinical trials have been published or are underway. More than 5,000 articles have now been published worldwide in the field of stereotactic radiosurgery. The University of Pittsburgh has the highest number of studies, having been cited more than 100 times. 

Each year more than 600 patients undergo Gamma Knife radiosurgery at the CIGNS, making it one of the busiest centers in the world. Each year, center faculty publish approximately 20 clinical research studies, now exceeding more than 700 combined peer reviewed publications and over 1,000 publications when book chapters and presentations are included.

In May of 2019, the 280-page volume Leksell Radiosurgery, coedited by Drs. Niranjan, Lunsford and Hideyuki Kano, MD, PhD, was published by Karger Publishers and represented a significant summary of the current role of the Gamma Knife.

In 2022, the third edition of Intracranial Stereotactic Radiosurgery was released by CRC Press, with Dr. Lunsford, and Jason Sheehan, MD, co-director of the Gamma Knife Center at the University of Virginia—and former fellow at the University of Pittsburgh—serving as editors.

More than 100 U.S. or international fellows have received training at this center since 1987. The center provides an opportunity for advanced training in image-guided stereotactic and functional surgery at the fellowship level. Current international research fellows are from China and Japan. The fellowship has two tracks, one for candidates interested in a functional focus (movement disorders, pain, and epilepsy) and one for candidates focusing on neurooncology and radiosurgery. This one-year PGY-7—or post residency—opportunity is approved by the Society of Neurological Surgeons Committee on Advanced Specialty Training (CAST). The first track, under the direction of Jorge Gonzalez-Martinez, MD, PhD, includes nine months spent on the functional neurosurgery service which includes epilepsy and movement disorder experience plus three months on the radiosurgery service. The second track includes nine months on the radiosurgery service and three months on the functional service. Currently, all PGY-3 residents spend three months each on the Gamma Knife service each year. 

The multidisciplinary Center for Image-Guided Neurosurgery includes the clinical and research efforts of neurosurgeon Dr. Kano and radiation oncologists John Flickinger, MD, Yoshio Arai, MD, Susan Rakfal, MD, and Zaid Siddiqui, MD. The participating medical physics group consists of Jong Oh Kim, PhD, Greg Bednarz, PhD and Tanvir Baig, PhD. Grace Yum provides assistance in medical informatics. Lana Trofimova, PAC, provides patient care assistance for the Gamma Knife program. Five full time dedicated, and very talented, nurses headed by Jonet Vacsulka, BSN, and assisted by RNs Mark Geminetti, Devi Willaman, Nancy Bastine, and Brenda Unghajer provide pre, intra, and post radiosurgery care to more than 600 patients every year. They are all especially trained in conscious sedation techniques to provide comfort and attentive care to our patients.

Kelly Powell, Dana Adams, and Julie Martin are an extremely capable administrative team that ensures prompt patient approvals and care.