When a patient is diagnosed with a cerebral aneurysm – or arrives in crisis following a subarachnoid hemorrhage – you need a referral partner that can respond at any hour with the full spectrum of neurovascular expertise.
A program built for the region
Nebraska Medicine offers Nebraska’s only Joint Commission Certified Comprehensive Stroke Center.
“Our role is to help this region,” says neurosurgeon Daniel Surdell, MD. “We try to be a helpful resource, and in that, offer consistency.”
That consistency is structural. The neurosurgery team – Dr. Surdell; William Thorell, MD; Nicholas Borg, MD; and Mithun Sattur, MBBS – provides attending-level coverage around the clock, so a colleague is always available for complex or demanding cases.
The program is also mission-driven in an explicit way. “We are committed to providing excellent service to the patient, educating the next generation and innovating,” Dr. Surdell says.
Full-spectrum aneurysm treatment
The neurosurgery team’s experience spans the full range of treatment options, including:
- Coil embolization: Soft platinum microcoils are deployed via catheter to occlude the aneurysm sac. Advances in catheter technology and microcatheter stability now allow precise treatment of aneurysms in the 3 mm to 5 mm range.
- Balloon- and stent-assisted coiling: Remodeling techniques for wide-necked aneurysms that would otherwise be poor candidates for coiling alone.
- Flow diversion: Devices deployed intraluminally to redirect flow and promote aneurysm occlusion via neointimal remodeling across the aneurysm neck.
- Open microsurgical clipping: Available for aneurysms where endovascular approaches are precluded by morphology – including wide-necked aneurysms with branch vessels arising from the neck – or where surgical durability is a primary consideration in younger patients.
“We try to go into it with a very thoughtful approach – what we think would be best for your patient,” Dr. Surdell says. “It’s a discussion and an agreement. Here are our options, and what’s best – and we individualize the care, patient to patient.”
The machinery behind every case
Dr. Surdell is quick to describe the program as more than its surgeons.
“I think of it as this enormous machinery for your patient’s success,” he says.
That machinery includes a neurocritical care team he describes as exceptional at moment-to-moment monitoring of aneurysm and stroke patients.
“I can’t tell you how much the experience in the ICU translates into timely intervention when there’s a problem,” Dr. Surdell says.
Advanced practice providers with deep subspecialty knowledge staff the clinic and keep close attention to detail. Stroke coordinators, floor nurses and rehabilitation therapists round out a team that Dr. Surdell says is oriented around one goal.
“We want the patient to have a good experience and a good outcome,” he says.
Subarachnoid hemorrhage care
The center is equipped to manage the full clinical course of aneurysmal subarachnoid hemorrhage. Upon transfer or presentation, the care pathway includes:
- Emergent imaging and diagnosis.
- CSF diversion for hydrocephalus when indicated.
- Aneurysm securement guided by clinical grade and time from ictus.
- Post-SAH neurocritical care, including electrolyte management and vasospasm monitoring and treatment.
- Daily cerebrovascular ultrasound.
- Monitoring for subclinical seizure activity.
- Early rehabilitation assessment.
The intensive SAH monitoring period typically spans two to three weeks and may include hydrocephalus management, vasospasm monitoring, electrolyte stabilization and CSF drain weaning.
Incidental aneurysm management
The neurovascular clinic sees a high volume of patients with incidentally discovered aneurysms. Treatment versus surveillance decisions are individualized based on aneurysm size, morphology, location, patient age and rupture risk data.
“For an older patient with a small aneurysm, five-year rupture risk data may mean more than it does for a younger patient with decades of life expectancy ahead,” Dr. Surdell says. “It’s a very personal discussion.”
Academic medical center advantage
The program’s training mission, Dr. Surdell says, is an advantage for patients – not a caveat.
“We are picking some of the most brilliant people to be our assistants, our helpers, our colleagues. They’re learning from us and we’re learning from them. That’s another set of eyes looking over things.”
Neurosurgery residents and fellows – many with six to seven years of specialty training – participate in patient care under direct attending supervision. The program also participates in clinical trials in the endovascular space, enabling access to emerging devices and contributing to advance the field.
Referrals
The Nebraska Medicine Stroke and Neurovascular Center accepts transfers and referrals 24/7. The team is available for consultation on complex or emergent cases and welcomes direct communication with referring providers.
For referrals or additional information, email physicianoutreach@nebraskamed.com or call 402.559.2500.