Center for Image-Guided Neurosurgery

The Center for Image-Guided Neurosurgery, (CIGNS) led by L. Dade Lunsford, MD, Lars Leksell Distinguished Professor, 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 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. 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 16,400 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 Chair in spinal neurological surgery.

The center also has a dedicated Elekta 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. Dr. Niranjan continues to pursue cutting edge research combining fiber tractography in the care of patients with refractory movement disorders and trigeminal neuralgia. The CIGNS has five committed nurses dedicated to optimal patient care from preoperative consultation to discharge from the outpatient center. They are all especially trained in conscious sedation techniques to provide comfort and attentive care to our patients.

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.

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 US, 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 that have been cited more than 100 times. More than 600 peer reviewed articles, several hundred book chapters, and 16 books have been published by individuals affiliated with this center since it opened in 1981.

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

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. 

This multidisciplinary Center for Image-Guided Neurosurgery includes the clinical and research efforts of neurosurgeon Hideyuki Kano, MD, PhD, 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, and Greg Bednarz, PhD. Grace Yum provides assistance in medical informatics. Lana Trofimova, PAC, provides patient care assistance for the Gamma Knife program.