WVU Medicine neurosurgeons provide advanced care to adults and children with disorders of the:

  • spine and spinal cord
  • brain, carotid, and vertebral arteries
  • pituitary gland
  • cranial and spinal nerves
  • autonomic nervous system

Expert treatment is given for spinal degenerative disease, herniated discs, spinal stenosis, neoplasms, and trauma.

Our faculty includes skilled surgeons at the forefront of new techniques in skull-base surgery, advanced stroke care, epilepsy surgery, pediatric neurosurgery, neuro-oncology, pain, and functional disorders.

State-of-the-art technology

WVU Medicine’s Center for Advanced Imaging offers state-of-the-art equipment that enables surgeons to diagnose and treat problems with a high degree of accuracy. This includes PET and a 3-Tesla MRI, which are twice as powerful as former MRIs. Three-dimensional angiography allows for better visualizations of complex aneurysms. Other technologies include a surgical aspirator and an 80-watt laser.

The Gamma Knife uses focused radiation to destroy lesions with pinpoint accuracy, while avoiding damage to surrounding tissue.

Advanced techniques

Our surgeons are skilled in the latest microsurgical techniques to treat aneurysms and AVMs, as well as pituitary, acoustic, and skull-base tumors in difficult-to-reach areas. Working with interventional neuro-radiologists, some lesions can be treated via blood vessels using catheters.

Patients can benefit from new advanced treatments, including those in clinical trials.

Treatments we perform include:

  • Surgery for spine trauma
  • Microsurgery of the brain and spine including the use of computer and endoscopic guidance
  • Treatment for benign and malignant brain tumors
  • Surgery for acoustic neuromas
  • Surgery for pituitary disorders
  • Surgery for spinal cord tumors
  • Surgery for hydrocephalus
  • Surgery for epilepsy
  • Dorsal root entry zone lesions
  • Cranial-facial reconstruction
  • Deep brain spinal cord, vagal nerve, and peripheral nerve stimulation
  • Surgery for trigeminal neuralgia

The Cranial Base Surgery Center at West Virginia University specializes in treating complex medical conditions involving lesions at the base of the skull. These include tumors, congenital anomalies, and infectious or inflammatory conditions. Because of the many important structures located in this area, cranial base lesions have long been some of the most difficult challenges for neurosurgeons and their patients.

Our surgeons are skilled in the most advanced techniques and the latest technologies, and we can offer help for conditions that previously may have been considered untreatable. We take a multidisciplinary approach to diagnosis and treatment, bringing together the insights of neurosurgeons, otolaryngologists, ophthalmologists, plastic surgeons, interventional neuroradiologists, radiation oncologists, and other skilled professionals to provide the most advanced and comprehensive care.

Conditions Treated

We treat patients with the following types of lesions in the cranial base region:

  • Aneurysms
  • Stroke requiring vascular bypass
  • Pituitary tumors
  • Acoustic tumors
  • Meningiomas of the cranial base, including:
    • Olfactory groove
    • Cavernous sinus
    • Petrous apex
    • Foramen magnum
  • Tumors of the clivus including chordoma
  • Tumors of the orbit
  • Tumors of the nasal sinuses extending toward the brain

Excellent outcomes

WVU surgeons are skilled in the latest minimally invasive surgical techniques and use of endoscopic approaches that provide for safer tumor removal and enhanced patient comfort. The goal is to maximize safe and effective treatment of lesions, while at the same time achieving excellent cosmetic outcomes.

State-of-the-Art Surgical Technology

State-of-the-art technology makes cranial base surgery possible. Our team approach is vital to providing the very best care and achieving the best possible outcomes for our patients.

State-of-the-art diagnostics

Advances in diagnostic technology have greatly increased physicians’ ability to pinpoint problems in the cranial base and to develop a precise treatment plan. We use the latest imaging technologies, including PET, 3.0 Tesla MRI, high resolution CT angiography, SPECT, and others that provide highly accurate images of the brain. While in the operating room, computerized image guidance allows our surgeons to visualize the operative area precisely.

Sophisticated neuro-monitoring enables surgeons to carefully follow the brain’s functioning even while a patient is asleep.

These include:

  • electroencephalography
  • somatosensory-evoked potentials
  • brainstem auditory evoked responses
  • intraoperative microsurgical Doppler
  • high-resolution cerebral angiography

Highly advanced treatment

New minimally invasive instruments, some developed by our own faculty, facilitate treatment of lesions in the most difficult-to-reach areas of the brain. The Center offers multi-faceted approaches to treating cranial base disorders, ranging from medical and surgical management to neurointerventional techniques, reconstructive surgery, and advanced radiation therapy including the use of the Gamma Knife.

WVU Medicine neurosurgeons provide advanced care for patients using the latest technology to alter and, in some cases, improve the function of the human nervous system. This is called neuromodulation. This surgery is often done in a minimally or non-invasive manner and can have dramatic results. These are some of the ways this technology is being used:

Movement Disorders, including Parkinson’s Disease

Movement Disorders are neurological conditions that cause abnormal increased movements, which may be voluntary or involuntary. Many can be treated effectively with medicine, physical and occupational therapy, and other conservative measures. Over time, these methods may stop controlling the symptoms of the disease, and neuromodulation can offer significant benefits for these patients.

  • Dystonia is a condition involving sustained involuntary muscle contractions with twisting, repetitive movements. It can affect the entire body (generalized dystonia) or one part of the body (focal dystonia).
    • Symptoms:
      • Begins in a single area, such as the leg, neck, or arm
      • Occurs during a specific action, such as handwriting
      • Worsens with stress, fatigue, or anxiety
      • Becomes more noticeable over time
    • Neuromodulation Options:
      • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that might help control muscle contractions.
  • Essential Tremor is a disorder that causes involuntary and rhythmic shaking. The trembling occurs most often in the hands but can affect almost any part of the body.
    • Symptoms:
      • Begins gradually, usually on one side of the body
      • Worsens with movement or postures
      • Usually occurs in the hands first, affecting one hand or both hands
      • Can include a “yes-yes” or “no-no” motion of the head
      • May be intensified by emotional stress, fatigue, caffeine, or temperature extremes
      • Usually runs in families
    • Neuromodulation Options:
      • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that stop the abnormal circuitry causing the tremor.
  • Parkinson’s disease is a slowly progressive, neurodegenerative disorder that causes tremor; stiffness; slow, decreased movement; or imbalance.
    • Symptoms:
      • A tremor, or shaking, usually begins in a limb, often in the hand or fingers
      • Slowed movement over time
      • Rigid muscles
      • Impaired posture and balance
      • Loss of automatic movements
      • Speech changes
      • Writing changes
    • Neuromodulation Options:
      • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that stop the abnormal circuitry causing the rigidity, slowness of movement, and tremor.

At WVU Medicine, there is a Parkinson’s support group that meets every month at HealthSouth in Morgantown.

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder is a psychiatric disease marked by irresistible thoughts and urges. Treatment includes talk therapy and medication. In severe cases, when patients are resistant to these methods, neuromodulation surgery may have a role.

  • Neuromodulation Options:
    • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that stops the abnormal circuitry causing the obsessive thoughts and urges.

Epilepsy

Epilepsy is a seizure when the brain has a burst of abnormal electrical signals over a short period of time. These signals cause the body and brain to react in certain ways. Anyone can develop epilepsy regardless of sex, race, ethnicity, and age. Most epilepsy can be controlled with medication, but a significant portion of patients with epilepsy continue to have seizures even with the best medical management. In the past, if these patients could not have curative surgery, there were no options for them. Now, neuromodulation can provide significant benefits in helping to control and limit their seizures.

  • Seizure Symptoms:
    • Temporary confusion
    • A staring spell
    • Uncontrollable jerking movements of the arms and legs
    • Loss of consciousness or awareness
    • Psychological symptoms, such as fear, anxiety, or déjà vu

At least two unprovoked seizures are generally required for an epilepsy diagnosis.

  • Neuromodulation Options:
    • Responsive Neurostimulation: Electrodes are surgically implanted into the brain in the areas that are most responsible for causing the epilepsy. They are connected to a generator that is implanted inside the skull. The generator can record seizures as they start and send signals back to the brain, causing the seizures to stop before they spread. This can prevent seizures from causing patients from losing consciousness and lower their number of seizures. Over time, the information gained from this device can allow some patients to have curative surgery for their epilepsy.
    • Vagal Nerve Stimulation: An electrode is surgically connected to the left vagus nerve and connected to a generator similar to a pacemaker. The generator can stimulate continuously in response to the patient’s heart rate or when the patient feels a seizure coming on. This device reduces the amount of seizures a patient suffers and decreases their overall severity.

Pain

Pain, such as angina (untreatable by other means), injuries to the spinal cord, nerve-related pain (such as severe diabetic neuropathy), peripheral vascular disease, complex regional pain syndrome, failed back syndrome, chronic radiculopathy, and other various types of pain, can be managed by spinal cord stimulation when conservative measures fail.

A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord.

Spinal cord stimulators come in three main types:

  1. Conventional implantable pulse generator, or IPG: A battery is placed in the spine during an operation. This can be a good choice for people with pain in just one body part because they need less energy to manage their pain.
  2. Rechargeable implantable pulse generator: A battery is placed in the spine during an operation. It can be recharged without another surgery. Because the energy source is rechargeable, these stimulators can put out more electricity. This may be a better choice for people with pain in the lower back or in one or both legs.
  3. Radiofrequency stimulator: This type of stimulator is an older design. It uses a battery that’s outside the body. This stimulator is rarely used today because of newer designs and better technology. This includes rechargeable batteries.

With all three types of spinal cord stimulators, the patient controls the level of electricity sent to the spine to make the treatment more effective.

Spasticity

Spasticity is a muscle control disorder that is characterized by tight or stiff muscles and an inability to control those muscles. Spasticity is caused by an imbalance of signals from the central nervous system to the muscles. It can be treated with a variety of conservative measures, including oral medications, muscle injections, physical and occupational therapy, and other options. When these fail, neuromodulation surgery may have a role.

  • Symptoms:
    • Increased muscle tone
    • Overactive reflexes
    • Involuntary movements, which may include spasms and clonus
    • Pain
    • Decreased functional abilities and delayed motor development
    • Difficulty with care and hygiene
    • Abnormal posture
    • Contractures (permanent contraction of the muscle and tendon due to severe persistent stiffness and spasms)
    • Bone and joint deformities
  • Neuromodulation Options:
    • Intrathecal Baclofen Therapy: Patients are given a trial dose of baclofen through a lumbar puncture. If the dose is effective in treating their symptoms, then a permanent pump and catheter can be implanted to deliver the drug continuously to the spinal fluid.
    • Selective Dorsal Rhizotomy: This is a surgery that stimulates the sensory nerves as they leave the spine using neuromonitoring in the muscles as well as physical therapy evaluations in the operating room to determine which sensory nerve roots are responsible for causing the spasticity in the muscles and then cutting only those. This can lead to dramatic improvements in spasticity of the legs without the need for permanent implants.

Research:

WVU Medicine is committed to advancing the frontiers of neuromodulation both in improving patient outcomes and broadening the applications for neuromodulation technology to help our patients. We are also using the unique opportunities afforded by neuromodulation technology to explore the basic functioning of the human mind. Our research efforts focus on addiction, cognitive and emotional functioning, pain, stroke recovery, unconscious body perception, balance and gait in Parkinson’s disease and other disorders, and many more.

Physicians:

Ali Rezai, MD – Executive Chair, WVU Rockefeller Neuroscience Institute

Ann Murray, MD

Nicholas Brandmeir, MD

Robert Marsh, MD

The Neuro-oncology program at WVU Medicine offers innovative, specialized treatments to patients with primary and secondary tumors of the brain and spine.

Brain tumors can be benign, which means there are no cancer cells, or malignant, with cancer cells that grow quickly.

Common Symptoms

Brain and spinal tumors can cause many symptoms. Some of the most common are:

  • headaches, usually worse in the morning
  • nausea and vomiting
  • changes in your ability to talk, hear, or see
  • problems with balance or walking
  • problems with thinking or memory
  • muscle jerking or twitching
  • numbness or tingling in arms or legs

Neuro-oncology Surgery

Surgical treatments for patients with brain tumors include the use of computer-guided navigation systems in the operating room. Procedures such as Gamma Knife radiosurgery (a highly precise form of radiation therapy) enable tumor removal through smaller openings while minimizing the irritation of surrounding brain tissue.

These techniques have greatly reduced the risk of surgery, improved patient comfort, and shortened hospital stays to frequently less than three days.

Surgical treatments occasionally involve the cooperation of other surgical disciplines, such as otolaryngology, oculoplastics, and plastic surgery when the tumors involve the ears, sinuses, or eyes.

What to Expect as a New Patient

When you come to WVU Hospitals for diagnosis and treatment, you will be evaluated by our team of experts from the departments of:

  • neurosurgery
  • neuropsychology
  • neurology
  • rehabilitation medicine
  • radiation-oncology
  • radiation physics
  • nursing
  • neuropathology
  • neuroradiology

We want to make your visits to WVU as convenient as possible. When you visit our clinic, you may meet with various team members on the same day so you won’t have to make multiple trips.

You will also need to bring your complete radiology files and any pathology slides from previous biopsies.

Rehabilitation will be a part of your treatment program when you come to us for care. We also provide educational materials and counseling sessions to you and your family. We want you to understand your condition and know the relative risks and potential benefits of the various treatment options available to you.