Departments

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.

We specialize in the treatment of headaches and facial pain in adolescents and adults. There has been enormous progress in headache medicine in the last two decades, starting with the development of the triptan class of medications, including Imitrex, to the recent approval of Botox treatment for chronic headaches. Our experts provide the best care possible.

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.

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)

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 Yale Gamma Knife Center is the only stereotactic radiosurgery unit in Connecticut dedicated to treating head and neck conditions. Gamma Knife radiosurgery is a type of focused radiation therapy used to treat certain types of tumors or abnormalities in the brain, its covering, and nerves and blood vessels. It is an effective, noninvasive alternative to brain surgery. Gamma Knife offers similar precision to open surgery with general anesthesia but with fewer risks and discomfort.Gamma Knife radiosurgery requires no incision and is done under local anesthesia.It is a one-day outpatient procedure and rarely requires hospitalization. Most patients return to their normal activities within 24 hours of the procedure. The experts in our Gamma Knife Center have more than 30 years of combined experience in radiosurgery. Our team works together to deliver a strong dose of precisely focused radiation. Gamma Knife can be used for both children and adults who meet the criteria for treatment with this advanced technology. Conditions we treat include: Brain metastases, most commonly from lung cancer, melanoma, breast cancer, colon cancer, renal cell cancer, and gynecological and genitourinary cancers Benign brain tumors such as meningiomas, acoustic neuromas (i.e., vestibular schwannomas), and pituitary adenomas Arteriovenous malformations Trigeminal neuralgia Intraocular melanoma Head and neck cancers, such as nasopharyngeal carcinoma Recurrent malignant primary brain tumors Glomus jugulare tumors Essential tremor (thalamotomy with Gamma Knife)

Yale neurointerventional radiologists are specialists who perform and interpret brain scans, and help guide endovascular neurosurgical procedures. Using only the highest-quality magnetic resonance and CT scanners, our doctors have both the expertise and advanced technology needed to quickly and accurately diagnose and treat conditions—both common and rare—that affect the brain.

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

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 Chênevert Family Brain Tumor Center at Smilow Cancer Hospital and Yale Cancer Center is an internationally recognized leader in comprehensive and multidisciplinary clinical care, and a hub of excellence for brain tumor research. Our team of specialists is dedicated exclusively to the care of patients with all types of brain tumors, and has extensive experience with: Primary brain tumors, such as glioblastomas, astrocytomas, oligodendrogliomas, primary CNS lymphomas, and others Brain metastases and leptomeningeal metastases, which originate from other cancers in the body Other primary tumors, such as meningiomas and schwannomas Rare brain tumors including craniopharyngiomas, medulloblastomas, ependymomas pineal tumors, pituitary tumors, and others All types of neurological complications of cancer and their treatments Our expertise covers all critical components for successful care for patients with brain tumors, from comprehensive diagnostic evaluation and state-of-the-art genomic tumor profiling, to innovative treatment options and cutting-edge clinical trials. We treat all patients, whether they are newly diagnosed or have already received extensive treatment. Our expert physicians are readily available to offer second opinions for patients from all over the country, and rapidly accommodate our patients for prompt evaluation and initiation of care. We also offer an extensive program to improve patients’ quality of life before, during, and after treatment, including psychosocial support, rehabilitation for memory impairment, and other resources. Diagnosis Our experts use state-of-the-art technology to diagnose brain tumors with detailed accuracy. Three Tesla MRIs offer highly sophisticated testing, such as functional MRI, MR spectroscopy, and positron emission tomography (PET). Experienced neuroradiologists read all brain scans and evaluate the images for diagnosis. Importantly, all brain tumors that are biopsied or removed at our program undergo whole exome sequencing, the most advanced technique available for tumor characterization, which can target the vulnerabilities of individual tumors. Medical Oncology Many brain tumors require chemotherapy, targeted therapies, or other medical treatments, often combined with radiation therapy and surgery. Our team of neuro-oncologists have extensive expertise in delivering oncology treatments, with a focus on achieving optimal efficacy and safety. Each patient receives an individualized and coordinated treatment plan, taking into consideration the tumor type, molecular and genomic information on the tumor, and the patient’s own needs and choices. Additionally, our patients have access to cutting-edge Yale clinical trials exploring multiple novel strategies to fight brain cancer. Radiation Oncology Established in 1958 as one of the first Radiation Oncology departments in the country, the Yale Department of Therapeutic Radiology has played a foundational role in the national development of