Reza Dashti, MD, PhD: Nuanced Treatment for Complex Cerebrovascular Conditions and Skull Base Lesions at Stony Brook University Hospital

By Jennifer Webster
Monday, July 29, 2019

Reza Dashti, MD, PhD, Associate Professor of Neurosurgery, Renaissance School of Medicine at Stony Brook University, and Associate Director of the Stony Brook Cerebrovascular Center, brings advanced treatments for both complex and common conditions to the people of Suffolk County.

Because Stony Brook University Hospital is Suffolk County’s only academic medical center, Dr. Dashti and his colleagues treat a wide range of brain and neurological conditions, from rare tumors to stroke. The diversity of his training is matched with the variety of cases he encounters. Most commonly, he focuses on stroke cases that need immediate intervention; other days, he may perform surgery on a patient with a brain aneurysm, an arteriovenous malformation, a cavernous malformation or a complex skull base tumor.

In particular, Dr. Dashti offers a rare type of microvascular surgery (bypass surgery) and applies a blend of techniques for connecting (anastomosis) a branch of scalp artery to a branch of brain artery by microsurgical approaches to improve compromised blood flow.

Minimally Invasive Approaches to Rare Tumors

At Stony Brook, patients with conditions such as pituitary adenomas, meningiomas, craniopharyngiomas and other rare skull base lesions often receive treatment via minimally invasive microneurosurgery. Following presurgical imaging, such as CT scan and MRI, the best approach to the lesion is planned out. The patient is positioned, and the surgeon correlates anatomic landmarks with presurgical imaging for stereotactic image guidance. Dr. Dashti uses a high-powered microscope to see the surgical field, while tiny instrumentation and small incisions lead to a virtually bloodless surgical site.

“We employ image-guided techniques and neuromonitoring, which monitors brain-body and body-brain signals, to make sure the surgery is safe,” Dr. Dashti says. “After the procedure, we perform an angiogram via an operating room microscope or conventional angiogram to make sure we have collected the information we need before closing up the surgical site.”

Stony Brook supports its microneurosurgical program with up-to-date equipment and technology, Dr. Dashti says.

“We have advanced surgical microscopes and neuromonitoring equipment, along with the highly advanced tools for intraoperative imaging,” he says. “From preoperative planning through the procedures themselves, we are well-equipped to provide the highest level of care for our patients.”

As modern imaging advances, additional microneurosurgical procedures become possible.

Advanced Cerebrovascular Care

Possessing deep experience in treating cerebrovascular lesions, Dr. Dashti has a rare combination of microneurosurgical and endovascular training, meaning he has the opportunity to turn a patient’s life around.

“My main interest is cerebrovascular medicine,” he says. “It requires a lot of knowledge and demands deep endovascular and microsurgical skills. It’s a very rewarding line of work — you can bring a person back from extreme illness, and they can go on to have a good quality of life.”

A large portion of Dr. Dashti’s time is devoted to treatment of cerebrovascular disease, including stroke and aneurysm. Stony Brook University Hospital is now a Joint Commission-recognized Comprehensive Stroke Center, which indicates its ability to receive and treat the most complex stroke cases around the clock and offer advanced techniques otherwise not available on Long Island when time is of the essence.

“Revascularization techniques and cerebral bypass are unique here,” Dr. Dashti says. “We also are the only center using mobile stroke units on Long Island. A CT scan is performed once the patient is in the ambulance, and a neurologist is able to remotely assess the patient. Clot-busting medication can be administered even before the patient arrives at a hospital. The patient is then triaged to the most appropriate facility based on their condition. Only a handful of centers in the United States offer this type of treatment for stroke patients.”

Dr. Dashti’s endovascular training helps him design and perform treatments for patients with aneurysm and other vascular complications. His unique perspective helps him decide whether an aneurysm may be most effectively approached endovascularly or through traditional surgery.

“With the advancement of our equipment, it is safe to perform endovascular treatment for most lesions,” he says. “But if the aneurysm is too small to deploy coils or stenting, or if I think that the risk of stenting and the subsequent need for anticoagulant therapy is greater than the risk of surgery, then I may go the surgical route. If endovascular treatment is not optimal, I use minimally invasive surgery with small craniotomies and minimal manipulation of the brain in order to correct the aneurysm.”

Advancement of the Art

Dr. Dashti has long performed research that informs his work in microneurosurgery and microvascular surgery. For example, he performs surgery for arteriovenous malformations, drawing on knowledge he gained through two years spent in Helsinki, Finland, studying — among other facets of the renowned program in cerebrovascular neurosurgery at the Helsinki University Central Hospital — the natural history of these rare tangles of blood vessels. His curiosity ranges from the natural history of brain and vascular disease to the best ways to perform a particular surgery.

“I have published a series of articles on the microneurosurgical treatment of brain aneurysms,” Dr. Dashti says. “The goal was to summarize the range of techniques available to treat these, and also to enable young neurosurgeons to improve their skills.”

As Associate Director of the Stony Brook Cerebrovascular Center, Dr. Dashti endeavors to continue moving the dial on microvascular and microneurosurgical techniques.

“I hope to use all our resources here, as well as my international connections, to plan research that leads to more information. That way, we can serve our patients even better,” he says. “At Stony Brook, we are available 24 hours a day, seven days a week, and our aim is to serve our patients in the best way possible.”

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