Departments

Our expert neurosurgeons specialize in utilizing Deep Brain Stimulation, or DBS, to restore function and quality of life in patients with all types of movement disorders, including Parkinson’s disease. We are the only DBS program in the tri-state area capable of performing all types of DBS implantation surgery, including asleep, frame-based, and frameless DBS. Our state-of-the-art operating room suite offers the accuracy of a powerful 3T MRI. Faulty pathway signals in the parts of the brain that control movement are at the root of many movement disorders. Previous surgical methods (such as ablation) destroyed brain tissue to eliminate the problematic signals. Instead, in DBS, the first procedure involves placing an electrode in the brain. Then, in a second procedure, surgeons connect the electrode to a tiny electrical generator implanted in the chest or abdomen. The generator delivers an electrical current to the area of the brain responsible for the symptoms and blocks them. While DBS is not a cure for movement disorders, it can substantially easesymptoms and decrease the number of necessary medications, limiting side effects and improving quality of life. DBS can also be effective for other conditions, including: Tremor:DBS has proven very effective in controlling and eliminating certain types of tremor. DBS is FDA-approved for the treatment of essential tremor and also helpful for a range of other tremor types. Dystonia:Select patients with severe dystonia have found significant benefit with DBS therapy. Patients with DYT1-positive dystonia have had good responses with this FDA-approved treatment. The effectiveness of DBS varies on the primary or secondary nature of the disease. We thoroughly review each patient to determine the potential benefit. Neuropsychiatric disease:Neurosurgery has long used techniques that destroy brain tissue to treat neuropsychiatric conditions. Today, we are exploring and expanding the use of nondestructive neuron-augmentation for psychiatric disorders, including depression and obsessive-compulsive disorder (OCD). DBS has been helpful for select patients with severe OCD. The use of DBS to treat other neuropsychiatric disorders, such as major depressive disorder and Tourette’s syndrome, is currently being studied, with promising results.

We cover all of the components critical to successfully managing patients with brain tumors. This includes comprehensive evaluation and diagnosis, genomic profiling of the tumor, leading-edge treatment options, follow-up, and psychosocial support. We welcome newly diagnosed patients as well as those who have already received extensive treatment elsewhere, along with patients in need of second surgeries or follow-up biopsies. We work closely with other Yale Medicine brain tumor doctors to provide a comprehensive, multidisciplinary approach that is patient-focused. Using advanced microsurgical techniques, including intraoperative neurophysiological monitoring and awake craniotomy (when appropriate), our brain tumor surgeons strive to achieve the maximum extent of tumor removal while preserving neurological function. Often, what is often deemed "inoperable" by some surgeons is considered operable at Yale with successful outcomes. We are the only hospital in the region to have MRI and angiography capabilities in our operating room. Yale New Haven Hospital also banks all tumor samples and performs genomic profiling to better understand tumor mutations. We use this information to help direct postsurgical therapy. Our state-of-the-art neurosurgical operating rooms in Smilow Cancer Hospital are the only in the regionto offer intraoperative MRI, intraoperative angiography, stereotactic surgical guidance, and operative brain mapping to precisely pinpoint brain tumors during surgery.These technologies, combined with our surgical expertise allow for the best in surgical care for patients. A team of experts dedicated to caring for patients with brain tumors, including specialized brain tumor surgeons, radiation oncologists, neuroradiologists, medical neuro-oncologists, neuropathologists, and other specialists meets weekly to arrive at the most advanced and appropriate treatment plan for each individual. Yale is one of the few centers capable of offering even more personalized and precise oncologic care, when appropriate, based on the genetic makeup of the individual’s tumor. Inquiries from referring physicians or directly from patients or their families are welcome. All inquiries are handled expeditiously by our team of experienced patient coordinators. Their role includes ensuring that appropriate appointments are made in a timely fashion, and coordinating with the various medical specialists involved in each treatment plan. New patients with brain tumors are usually seen within two or three days. Our patient coordinators also act as patient advocates, communicating with the various medical specialists contributing to the treatment plan. Through Yale’s strong tradition of and commitment to research, practitioners are well acquainted with the most advanced treatment methods and have access to clinical trials. Patients also benefit from the specialized resources at Smilow Cancer Hospital and Yale New Haven Hospital, such as an advance

The recurrent seizures that herald epilepsy come from sudden, temporary disturbances in the normal function of the brain’s electrical system. While many people with epilepsy can be successfully treated with anti-epileptic drugs that provide partial or complete control over seizures, many do not respond to medication, or even a combination of multiple medications. As a result, they may experience catastrophic epileptic seizures daily, making any semblance of a normal life impossible. At Yale, we offer promising options for many of these patients. Our experts are world-renowned, specializing in the treatment of new-onset epilepsy in children and adults, as well as medically intractable seizure disorders. Our Epilepsy and Seizure Center was one of the first of its kind, and we continue to lead the way as one of the most advanced and active programs in the world. More epilepsy surgeons around the country received their training at Yale than at any other program in the country. We see both children and adults for second opinions, diagnostic evaluation, and first-time seizures. We provide treatment recommendations for all types and severity of epilepsy or possible epilepsy. Our multidisciplinary team includes epileptologists, neurologists, neurosurgeons, neuropsychologists, neuroradiologists, neuropathologists, and psychiatrists. Nurses, technicians, technical staff, and administrative staff are also key players in patient care.Our neurologists work in collaboration with neurosurgeons and diagnostic radiologists to deliver intensive and innovative therapeutic and diagnostic services for patients with varying forms and degrees of seizures and epilepsy. Specialists perform intensive audiovisual and EEG monitoring for diagnosis and localization of the affected area. We evaluate our patients in phases to precisely coordinate electrophysiology, cognitive testing, medical history, and physical and neurological examination with advanced imaging using MRI, SPECT, and PET techniques.

The Yale Neurosurgery Normal Pressure Hydrocephalus (NPH) Program is the busiest NPH program in Connecticut and one of the busiest in the region and the nation. Our highly specialized team consists of dedicated physicians, nurses, nurse practitioners, physical therapists, and occupational therapists who care for patients with NPH and are well versed in its presentation, progression, and treatment. NPH is a condition characterized by the buildup of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. It is a condition of “too much water in the brain.” It is not fully understood why this happens, but when this fluid or “water” builds up in the brain, the patient can develop trouble walking, difficulty controlling urine, and have mild memory loss or impairment. Roughly over 700,000 Americans have NPH, although less than 20% are appropriately diagnosed. Diagnosis requires a systematic approach. At Yale, our specialists most often use a 3-day inpatient trial of lumbar drain trial to help determine if symptoms respond to removing the extra fluid in the brain. In addition, while patients are receiving inpatient care, they are evaluated by physical and occupational therapists. If a patient demonstrates improvement we then recommend placement of a permanent drain or shunt, which is most often performed on the same admission. At Yale Neurosurgery we are committed to providing the best care for individuals who have or are suspected of having NPH. We work with patients, their families, and other caregivers to understand the impact the symptoms are having on their life. We look forward to caring for our patients and their family members.

At Yale Medicine Neurosurgery, we care for adults and children with neurological disorders of the central and peripheral nervous system. These types of conditions affect the brain, spinal cord, and nerves which send messages from brain to the rest of your body. Our team is comprised of highly trained surgeons, researchers, and clinicians who are all focused on delivering expert care for conditions related to the brain and spine. Each neurosurgeon on our team has extensive training in their respective areas of neurosurgery. Conditions we treat include: All types of primary brain tumors, including gliomas, glioblastomas, and meningiomas Brain and spine trauma Cerebrospinal fluid disorders (such as normal pressure hydrocephalus) Epilepsy Metastatic brain, spine, and spinal cord tumors Movement disorders (including Parkinson's disease and tremors) Neurovascular disease (aneurysms, arteriovenous malformations, ischemic and hemorrhagic stroke, and carotid artery stenosis) Pain disorders (such as trigeminal neuralgia) Pediatric and congenital disorders (including hydrocephalus, craniosynostosis, spina bifida, and congenital spine deformities Peripheral nerve syndromes (such as carpal tunnel syndrome) Pituitary tumors (adenomas) Spasticity (including multiple sclerosis) Spinal disorders (such as herniated disks, stenosis, and scoliosis)

Yale’s Department of Neurology has been at the forefront of cutting-edge clinical care and scientific discovery since it began in 1952. It was Yale scientists who discovered the genes that cause Multiple Sclerosis. Yale housed one of the first epilepsy monitoring units in the country, and one of the first stroke centers at its partner, the Veterans Affairs (VA) Center in West Haven. Today, our team of experienced doctors are committed to understanding and treating the entire spectrum of nervous system diseases. Expert physicians specialize in brain and nerve health for both children and adults. Specialized care is offered in the following areas: Amyotrophic lateral sclerosis (ALS), myasthenia gravis, peripheral neuropathy, neuromuscular disorders Alzheimer’s disease/cognitive disorders Epilepsy and neurophysiology General neurology, headache, pain Multiple sclerosis and neuroimmunology Neurodegenerative disorders Neurocritical care Neurological infections Neuro-oncology Parkinson’s disease and movement disorders Stroke and vascular neurology

Internationally known for clinical excellence and cutting-edge research, we provide promising treatment options for adult and pediatric patients. Our program was one of the nation's first, and has evolved into one of the most active and advanced in the world.Yale is internationally recognized as a leader in innovative treatment for medically intractable and new onset epilepsy. We treat patients in outpatient settings, at a six-bed adult epilepsy monitoring unit, a two-bed pediatric epilepsy monitoring unit, and a technologically advanced operating suite. We are also equipped with state-of-the-art technology for continuous brain and video monitoring of seizures in children and infants. We evaluate patients in phases to precisely determine concordance of electrophysiology, cognitive testing, history, as well as physical and neurological examination with advanced imaging, using MRI, SPECT, and PET techniques. Doctors treat each surgical patient as an individual, determining which procedure or combination of procedures is appropriate.

Our highly skilled and experienced team specializes in electrophysiology, or the diagnosis and treatment of heart-rhythm abnormalities, also known as arrhythmias. We treat complex arrhythmias and structural heart disease at Yale New Haven Hospital and through several outpatient office locations. At Yale New Haven Hospital, our physicians operate Connecticut’s largest and most comprehensive program for ventricular tachycardia ablation, a procedure that eliminates the heart tissue that causes arrhythmia. Our Complex Ablation Program offers epicardial ablation to treat ventricular tachycardia and atrial fibrillation that originates from the outer surface of the heart. Our operating suites are equipped with cutting-edge technology, including three-dimensional mapping systems, intracardiac ultrasound, and robotics. We offer a full range of device therapies, including pacemakers, defibrillators, and cardiac resynchronization therapy (CRT). We routinely monitor implantable devices using remote technology to ensure patients’ safety, wherever they are. We also offer a clinic in which doctors from electrophysiology and geriatrics work together to manage patients with recurrent falls and syncope, or fainting caused by low blood pressure. Additionally, Yale New Haven Hospital runs the only Atrial Fibrillation Support Group in the state. The group is for all patients and their families and aims to help individuals and their loved ones cope with the psychological and emotional burdens of their disease. For patients at Yale New Haven Hospital, an advanced nurse practitioner dedicated to arrhythmia management is ready to assist, working closely with physicians to ensure a seamless inpatient to outpatient transition.

We evaluate, diagnose, and manage children and young adults with problems involving the brain, spinal cord, peripheral nervous system, and muscular systems. Our highly trained physicians offer child-friendly, family-centered care and are experts in treating nervous system disorders including: Epilepsy and seizures Learning disabilities, including developmental delay, cerebral palsy, and dyslexia Headaches and migraines Migraine and other pain syndromes Movement and paroxysmal disorders Multiple Sclerosis and white matter disease Muscular Dystrophies, Guillain-Barre syndrome, and other nerve and muscular disorders Spinal cord disorders, including myelomeningocele and spinal muscular atrophy Stroke and other cerebrovascular disorders Our special services include: Comprehensive epilepsy evaluation, including inpatient combined electroencephalogram (EEG) to measure electrical activity in the brain and video monitoring for epilepsy Evaluation and management of full-term and premature infants with potential nervous system problems

The Pituitary Program is a destination center for the clinical management of pituitary, parasellar, and anterior skull base disease delivering state-of-the-art, multidisciplinary care. It is the referral center for the state of Connecticut for treatment of complex pituitary and sellar-parasellar pathology using the expertise of minimally invasive endoscopic skull base surgery jointly performed by neurosurgery and ENT. Patient cases are reviewed by a multidisciplinary pituitary tumor board, with intraoperative hormone monitoring, intraoperative MRI, and whole exome sequencing of tumors for potential genomic-based diagnosis and treatment. The Yale endocrinology team and other supporting subspecialties follow each patient during the hospitalization for uninterrupted endocrine care. We aim to maximize the quality of care and the ultimate outcome of each patient. To ensure the best care possible, we co-manage the pituitary disorder with each patient’s primary care physician, and actively seek second opinions, exploring dynamic testing and pituitary hormone replacement therapy options. Yale New Haven Hospital is a regional center for pituitary surgery, and our physicians have specific expertise in treating a variety of neuroendocrine diseases, including Cushing's disease and adult growth hormone deficiency syndrome. We also evaluate and treat reproductive disorders in collaboration with the sections of Reproductive Endocrinology and Infertility. Additionally, we work closely with colleagues in neurosurgery, surgical endocrinology, therapeutic radiology, and other departments to make sure patients benefit from our patient-centered, team-based approach. Combined with first-rate technology at Yale New Haven Hospital, the Yale Cancer Center and the Department of Neurosurgery’s Gamma Knife Center, the Pituitary Program is uniquely positioned to offer every diagnostic and treatment option available, including: Dynamic pituitary magnetic resonance imaging (MRI), an enhanced diagnostic imaging technique Inferior petrosal sinus sampling to sample hormones from the veins that drain the pituitary gland 3-D conformal radiotherapy to better target tumors Intensity-modulated radiation therapy, an advanced high-precision technique Transphenoidal surgery performed through the nose and sphenoid sinus Gamma Knife surgery (stereotactic radiosurgery) performed at the Gamma Knife Center, the only dedicated Gamma Knife facility in Connecticut. At Yale New Haven Children's Hospital, our longstanding pediatric endocrinology clinic provides the same services and excellence of care that adults receive.

We are dedicated to delivering expert primary and referral services for all disorders of the peripheral nerves and muscles. Our program is supported by the Muscular Dystrophy Association (MDA). As a tertiary referral site for complex neuromuscular conditions, we serve as consultants to general neurologists, internists, and many other specialists. We specialize in: ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) Myasthenia Gravis Myopathy (including polymyositis, dermatomyositis, inclusion body myositis) Neuropathy (CIDP, CMT and other inherited neuropathies, Guillain-Barré, diabetic neuropathy) Muscular Dystrophy (including FSH, Duchene, Becker, Limb-Girdle, Myotonic, Oculopharyngeal) Stiff-Person Syndrome and related disorders Our neurologists have advanced training in neuromuscular disease and electromyography (assessing electrical activity in muscle). They have specialized knowledge in the science, clinical evaluation, or clinical management of disorders that affect cells in the central and peripheral nervous systems, muscles, and the junction between them. They offer greater expertise in the origin, mechanisms, diagnosis, and treatment of these disorders than general neurologists. Our electromyographers have expertise in assessing electrical activity in muscle and nerve conduction studies. We are one of the few programs in the Northeast with several electromyographers, who are expert in a specialized technique called single fiber EMG to test for myasthenia gravis. Our neuromuscular group works together as a team that includes medical assistants, clinical nurse coordinators, an MDA coordinator, resident staff, fellows, and attending physicians. Please bring the following items: A copy of your medical records pertaining to your condition, which should include MRIs, nerve conduction studies, and other testing and/or imaging available A current list of all medications and any allergies to medications Name and address of your primary care physician and any other specialists Your first visit will entail a comprehensive evaluation, and you will be asked for a detailed history of your condition. We will complete a thorough neurological examination, after which we will develop a plan of care. We will inform you if additional testing is needed, make recommendations regarding adjustments to current treatment regimens, or refer you to other physicians or consultants. The term EMG is often used to refer to both electromyography and nerve conduction studies. Electromyography is the technique of assessing the health of muscles. Nerve conduction studies assess the health of nerves. Together these techniques are used to investigate and diagnose the entire spectrum of neuromuscular disorders. Our electomyographers use the latest EMG equipment to perform all available specialized EMG techniques, including Quantitative EMG, Blink Reflex, Single Fiber EMG, and others. We use a specialized type of nerve conduction study, called the Jolly

The Pediatric Epilepsy Program studies and treats epilepsy and seizure disorders. The program is equipped with state-of-the-art technology for continuous electroencephalographic and video monitoring of seizures in infants and children. This facility represents one component of a comprehensive evaluation and treatment program for children with epilepsy. Recognizing that 6% of the pediatric population experiences at least one seizure in a lifetime, Pediatric Neurology is committed to understanding the nature of seizure disorders in children. Our team of dedicated experts offers a multidisciplinary approach to care that integrates the expertise of colleagues in neurosurgery and diagnostic imaging to deliver leading-edge evaluation, diagnosis, and patient care to children with varying forms and degrees of seizure and epilepsy. Our Program provides intensive audiovisual and electroencephalography (EEG) monitoring for diagnosis and localization of the affected area, to tailor care for each patient. Patients receive comprehensive inpatient and outpatient services, and a full range of medical and surgical treatment options, including ketogenic diet and vagus nerve stimulator programs for the treatment of children with complex epileptic conditions, as well as investigative therapies and approaches that are not widely available.