Departments

Timely treatment is essential to maximizing quality of life after a stroke. At the Yale Stroke Center, our highly skilled physicians take pride in delivering safe, patient-centered, and efficient care. We provide emergency treatments for conditions such as acute stroke and brain bleeds, where immediate interventions are required, but also elective treatments for aneurysms and other vascular lesions that are discovered incidentally. A dedicated neurovascular surgeon is on call and ready to mobilize a team at a moment’s notice—24 hours a day, 7 days a week. We streamline access to emergency neurovascular care for referring physicians, guaranteeing that patients will receive the timeliest and best care anywhere. Our collaborative team includes neurologists, neurosurgeons, and neuroradiologists, as well as physical medicine and rehabilitation specialists, working together to deliver cutting-edge interventional treatment and imaging. In the emergency department, radiologists are always available to provide readings of imaging scans so that patients can proceed as quickly as possible to treatment. We have an array of 3-D imaging workstations to ensure doctors can pinpoint where they need to concentrate care. We work closely with Yale New Haven Hospital’s emergency medical service and emergency department teams to rapidly diagnose and treat acute stroke and other cerebrovascular disorders 24 hours a day. Our Y Access Line allows for the quick and easy transfer of patients to Yale New Haven Hospital. We also offer SkyHealth, an emergency patient transport helicopter, staffed by highly skilled medical professionals, including a critical care flight nurse and a trained paramedic. Life-saving interventions are delivered en route, for the best possible clinical outcomes. Our state-of-the-art, VISIUS Surgical Theater is equipped with a powerful MRI and an integrated, bi-plane X-ray angiography system that allows our experts to better visualize arteries and vessels. The ability to receive preoperative diagnostic imaging; open micro-surgery; percutaneous, catheter-based endovascular treatments; and postoperative checks all in the same room is unique in the tri-state area. Our services include: A dedicated neurointensive care unit A stroke consult service with a patient- and family-centered approach to the treatment and rehabilitation of patients with cerebrovascular disease Specialized stroke clinics for community physician referrals, stroke consults, and primary and secondary stroke prevention Telemedicine Program Through our Stroke Telemedicine Program, our neurologists use a video- and image-sharing telecommunications system to provide acute stroke care consultative services to outlying hospitals in the state. Yale New Haven Hospital is the only hospital in Connecticut to offer stroke telemedicine services. Within minutes of making an initial call to the Stroke Telemedicine Program, an on-call neurologist can examine a patient at the remote hospital to hel

The Yale Medicine Interventional Radiology (IR) program is one of the leading programs in the nation. Our interventional radiologists, recognized as pioneers in the field of minimally invasive medicine, work with nursing and technologist staff to offer image-guided, non-surgical treatments for vascular and non-vascular disease with excellent outcomes for pediatric and adult patients. Our interventional radiology procedures are performed for a broad range of conditions spanning gastrointestinal/hepatobiliary, gynecology, infectious disease, oncology , pediatrics, pain management, urology, and venous and arterial disease. Interventional radiologists use advanced imaging modalities including ultrasound, fluoroscopy, computed tomography, and magnetic resonance imaging to perform procedures through tiny pinholes, thereby avoiding surgery and long recovery times. IR advances enable minimally invasive treatment of many conditions on an outpatient basis, allowing patients to recover in the comfort of their own home. We also offer comprehensive care dedicated to the treatment of pediatric patients, including vascular malformations, biopsy service with sedation, feeding tube maintenance, and expert care in hepatobiliary, urological, gastrointestinal, and musculoskeletal disorders. Our team at Yale New Haven Hospital was the first in Connecticut and among the first in the nation to perform transcatheter pulmonary embolectomy, a procedure for the removal of a blood clot from the pulmonary arteries. Such patients are initially evaluated by a multidisciplinary Pulmonary Embolism Response Team (PERT) , and a comprehensive treatment plan is then developed. We also have one of the world’s leading hereditary hemorrhagic telangiectasia (HHT) and vascular malformation programs. Founded in 1994, both serve as role models for other programs around the world. We offer a wide range of minimally invasive Interventional Radiology treatments, all available at Yale New Haven Hospital. Heart and vascular Angiography, angioplasty, and stenting for arterial disease Embolization for acute, traumatic gastrointestinal and genitourinary bleeding Endovascular treatment of aneurysms and pseudoaneurysms Inferior vena cava filter placement and removal Non-surgical dialysis fistula creation and repair Pulmonary embolectomy to remove pulmonary embolism (blood clot in the lungs) Treatment of arteriovenous malformations Venography, venous stenting, and related procedures for venous occlusion and clot Venous ablation for varicose veins Gastrointestinal/Hepatobiliary Gastrojejunostomy placement and gastrostomy for nutrition Transjugular intrahepatic portosystemic shunt (TIPS) placement for upper GI bleeding and refractory ascites Treatment of benign and malignant bile duct obstructions Treatment of fluid collections in the abdomen, chest, and pelvis Gynecology Fallopian tube recanalization for infertility Uterine fibroid embolization for fibroids and uterine artery embolization fo

With the latest microsurgical and endovascular technologies, we offer unparalleled treatment to patients with all types of neurovascular disease affecting blood vessels in the brain and spinal cord. This includes aneurysms, vascular malformations, and artery and venous stenosis, or blockages. Our cutting-edge research also allows for more refined, personalized medicine. Our expert clinicians specialize in managing all types of brain, neck, and spinal cord vascular disorders. Our therapeutic treatment strategies include: Open microsurgery Less invasive endovascular (interventional) treatment Stereotactic radiation (Gamma Knife radiosurgery) Rehabilitation

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 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.

For patients at other Connecticut hospitals who present with acute stroke symptoms, our Stroke Telemedicine Program allows local providers to consult with our neurologists via video- and image-sharing technology. Within minutes of making an initial call to the Stroke Telemedicine Program, the on-call neurologist can examine a patient at the remote hospital to help diagnose and make recommendations for treatment. Yale New Haven Hospital is the only hospital in Connecticut to offer stroke telemedicine services. Some patients who present with the opportunity for treatment with IV tPA may be transferred to Yale New Haven Hospital. tPA is the only FDA-approved treatment for strokes caused by blocked blood vessels, which account for the vast majority of them. Stroke telemedicine programs throughout the country have demonstrated that telemedicine conferencing between outlying hospitals and trained stroke neurologists can improve outcomes for stroke patients, enhancing the use of tPA at hospitals that do not have on-site neurologists 24/7.

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

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.

At the Yale New Haven Stroke Center, we offer safe, effective, patient-centered, timely, efficient, and equitable care to patients with strokes. In collaboration with the hospital’s emergency medical service and emergency department teams, we deliver rapid diagnosis and treatment of acute stroke 24 hours each day. Our center is a Joint Commission Primary Stroke Center, a national recognition of our expertise in providing the highest level of care to stroke patients. From prevention to treatment to recovery, we have the most experienced doctors and the latest diagnostic tools, techniques, and treatments. Our patients receive rapid access to treatment by a highly experienced team that includes experts in vascular neurology, endovascular surgical neuroradiology, neurovascular surgery, neurocritical care, physical medicine and rehabilitation, emergency medicine, and other medical subspecialties. Our multidisciplinary team works together to diagnose and determine the most appropriate treatment for our patients. Timely, effective treatment can make a significant difference in quality of life following recovery. We follow best practices to try to preserve brain function and prevent serious injury. Our services include: Dedicated neuro-intensive care unit Stroke consult service with a patient- and family-centered approach to the treatment and rehabilitation of patients with cerebrovascular disease. Specialized stroke clinics for community physician referrals, stroke consults, and for primary and secondary stroke prevention.

We recognize that anyone diagnosed with cancer is considered a survivor from the moment of their diagnosis. We provide individualized treatment summaries and survivorship care plans to support ongoing recovery and long-term survival. We are dedicated to enhancing the quality of life for individuals impacted by cancer. We value an inclusive approach and try to meet you “where you are at,” taking care of you as a whole person. Our team of experts have the highest level of oncology training in their field. We create a supportive space to hear you voice your concerns and focus on validating and empowering you to meet your goals by using practical tools. Established in 2006, our Survivorship Clinic was the first multidisciplinary resource for cancer survivors in the State of Connecticut to provide patients and their families with vital information on cancer prevention, wellness, supportive services, and the latest health research related to cancer survivorship. Our team understands that having cancer can be a life-altering experience. Survivors often have to adapt to a “new normal” that includes lifestyle changes. Because every survivor’s experience is different, each patient who visits our Survivorship Clinic receives an individualized care plan with specific recommendations and support for issues ranging from social and emotional wellness to nutrition recommendations and exercise guidance. Plan for a 2-hour visit. At the initial visit, you will meet with each provider one-on-one for 30 minutes. During this time, each provider will offer an opportunity to discuss your concerns related to their field of practice. Together, you both develop a plan to move forward living well beyond your cancer diagnosis and treatment. We see patients on average 1-3 times, depending on each patient’s needs. The Survivorship Clinic offers referrals to additional services based upon the discussion and needs identified at your visit.

The Palliative Care Program at Smilow Cancer Hospital focuses on symptom management and quality of life concerns for adult patients with serious chronic progressive or terminal illnesses. We center our care on patients and families, and help them deal together with their loved ones’ physical issues such as pain, fatigue, and nausea, as well as with psycho-social issues like depression, disruption of family life, and financial concerns. Each patient consultation includes a comprehensive review of medical records and medical history, a physical examination, and a discussion of the symptoms, goals, values, social interests, and spiritual needs of the patient and his or her family. Ongoing evaluation and follow-up care are then provided as needed. Palliative care uses many approaches, depending on the individual patient’s symptoms, needs, and wishes. It might involve the following: Medications Pain management Complementary techniques, including breathing exercises, massage or Reiki, acupuncture, art or music therapy Mental health services and coping strategies Relaxation techniques Spiritual support and guidance Nutritional support Family support Discharge planning The palliative care team includes expert physicians and advanced practice providers who partner with social workers, chaplains, pharmacists, care coordinators, and other clinical staff members to offer an additional dimension of expertise. Our staff is experienced in helping patients and families manage distress in the face of serious illness, as well as at life’s end. It’s important to note that unlike hospice care, which is meant specifically for those approaching the last stages of life—usually the final six months—palliative care can complement ongoing treatment at any stage of illness. Palliative care does not mean that active treatment to cure a disorder or prolong life will end. All care will continue through any stage or time in each patient’s illness. Bereavement Service Yale New Haven Hospital Bereavement Services provides care and support to families and friends to help you learn how to live life without your loved one. Grief is a natural response to loss, but the way we grieve is unique to each person. Our experienced staff of clinical social workers can help with learning and understanding more about grief which will help with healing. Services Telephone outreach Monthly bereavement seminars Bereavement support groups Information and referral for bereavement resources Hope for the Holidays (support for coping during the holiday season) Annual Memorial Service (a formal service to remember your loved one, conducted in collaboration with Spiritual Care and Patient Relations) For more information, contact: Andrea Lucibello, LCSW Coordinator of Bereavement Services 203-688-0726 Outpatient Palliative Care The Outpatient Palliative Care Clinic at Smilow Cancer Hospital uses an interdisciplinary team approach to provide an extra layer of support for both patients and thei

The focus of the team of clinicians who form the Gynecologic Oncology Program at Smilow Cancer Hospital is to provide comprehensive and compassionate care for women with gynecologic cancers. Women diagnosed with vulvar, vaginal, cervical, uterine, fallopian tube, or ovarian cancers are provided with exceptional care from Yale’s experienced team of gynecologic oncologists at the hospital’s dedicated Women’s Center. In addition, the team also treats soft tissue tumors of the pelvis, gestational trophoblastic disease, as well as women with precancerous changes that have been identified in the vulva, vagina, and cervix, including dysplasia and carcinoma in situ, or premalignant changes of the endometrium, including adenomatous hyperplasia. The physicians of the Gynecologic Oncology Program offer a wide spectrum of advanced strategies for the diagnosis and treatment of gynecologic cancers, including colposcopy evaluation, conformal radiotherapy, and novel, targeted chemotherapies. The multidisciplinary program has experts from the obstetrics, gynecology, and reproductive sciences; radiation oncology; radiology and biomedical imaging; genetics; pathology; pharmacy; and social work. A dedicated patient coordinator facilitates patient appointments and communication, coordinates services, and supports each patient and their family. Surgery for previously untreated gynecologic cancer Surgical treatment of cancer is the most common option for previously untreated cancers. These operations include radical hysterectomies for cervical cancer, cytoreductive surgery for ovarian cancer, radical vulvectomies for vulvar cancer and total abdominal hysterectomies, bilateral salpingo-oophorectomies, and lymphadenectomies for the staging and treatment of endometrial cancers. Conventional laparoscopic and robotic surgery is available to women in need of surgery for uterine cancer, as well as for removal of the uterus, tubes, and ovaries. Prophylactic surgery, including hysterectomy, bilateral salpingo-oophorectomy, or bilateral salpingectomy with ovarian conservation, is also available to women looking to prevent ovarian cancer occurrence. Preservation of fertility in women with gynecologic cancers whenever possible is always a priority. We perform radical trachelectomies in women with early-stage cervical cancer who desire fertility preservation. For women with early-stage, low-grade endometrial cancers, hormonal therapy is prescribed. Chemotherapy Management The Gynecologic Oncology Program provides a full spectrum of chemotherapeutic agents used in the management of ovarian cancer, fallopian tube cancer, uterine cancer, mesenchymal tumors of the uterus, cervical cancer, vaginal cancer, and vulvar cancer. These chemotherapeutic agents may be used either for primary treatment or treatment of recurrent disease. Neoadjuvant chemotherapy, i.e., chemotherapy prescribed before surgical treatment, is often used for women with advanced ovarian cancer to reduce the s