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 center to initiate a clinical program for Gamma Knife stereotactic radiosurgery in 1987, the Center for Image-Guided Neurosurgery continues to be an international  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 unit is booked for reloading of the Cobalt 60 sources in 2023, during which we hope to upgrade it to the latest generation Gamma Knife technololgy. This latest generation Gamma Knife unit incorporates advanced robotics, expands the role of radiosurgery to include cranial vertebral junction targets, provides greater patient access, and enhances patient safety.  The ICON® Gamma Knife  incorporates a cone beam CT imaging system in order to facilitate a mask stereotactic fixation system for selected patients.

Gamma Knife technology represents one of the most advanced and minimally methods to treat  patients with brain tumors, arteriovenous malformations (AVMs), and pain or movement disorders. Over 17,750 patients have undergone Gamma Knife stereotactic radiosurgery at UPMC Presbyterian. In addition, spinal radiosurgery using several radiosurgical systems is offered under the direction of neurosurgeon Peter Gerszten, MD, who serves as the Peter E. Sheptak Endowed Professor at the University of Pittsburgh.

In 2021, UPMC installed the new MEGIN NeuroMeg TRIUX® magnetoencephalography (MEG) unit to perform functional brain mapping in patients with brain tumors, epilepsy, trauma and degenerative brain disorders. Dr. Niranjan is the operations director of the MEG project. He continues to pursue cutting edge MEG research that seeks to develop more specific paradigms to pinpoint the anatomic areas of speech, visual, motor, and sensory function. The new MEG unit includes a helium recycling device that significantly reduces the annual cost of helium replacement needed to supercool the detectors of tiny MEG brain waves.
 
The Center for Image-Guided Neurosurgery is 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—during the early COVID pandemic—the center switched to online Gamma Knife training courses. Course participants from around the world become “temporary” students at the University of Pittsburgh for one week. Instruction is possible using more than 35 lectures, videos, and course materials. Hands on training in collaboration with Elekta, Inc. allows students to temporarily and remotely turn their personal computers in radiosurgery planning work stations. Students can now study radiosurgery effectively, avoiding the local housing and transportation costs 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. Finally, neurosurgery residents at UPMC spend a three-month dedicated block for study during their third year of training to complete certification in brain radiosurgery, typically participating in more than 150 cases during the rotation. 

In addition, the center conducts numerous clinical, long-term outcome research projects (typically producing 20+ peer reviewed publications each year). CIGNS 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, Asia, Africa, Europe, and Asia. Multiple retrospective clinical trials have been published or are underway. More than 10,000 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 1,400 publications when book chapters and presentations are included.

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. The CAST-approved fellowship has two tracks, one for candidates interested in a functional focus (movement disorders, pain, and epilepsy with study supervised by Jorge A. González-Martínez, MD, PhD) and one for candidates focusing on neurooncology and radiosurgery (supervised by Drs. Lunsford and Niranjan). The functional track includes epilepsy and movement disorder experience plus three months on the radiosurgery service. The radiosurgery 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 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. 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.