Center for Cerebrovascular Care: Complex Cerebrovascular, Neurovascular & Skull Base Referral Program

Complex cerebrovascular disease rarely fits neatly into a single specialty. Patients with intracranial aneurysms, arteriovenous malformations (AVMs), Moyamoya disease and other complex neurovascular disorders often require coordinated expertise from multiple disciplines to determine the safest and most effective treatment approach.

At Cleveland Clinic in Florida, the Center for Cerebrovascular Care—Complex Cerebrovascular, Neurovascular & Skull Base Referral Program serves as a regional referral destination for physicians seeking advanced evaluation, expert second opinions and comprehensive treatment planning for patients with complex cerebrovascular disease. Bringing together specialists in vascular neurology, cerebrovascular and skull base neurosurgery, neurointerventional surgery, neurocritical care and advanced neuroradiology, the program offers individualized care supported by multidisciplinary decision-making from diagnosis through long-term follow-up.

The program is designed with referring physicians in mind. Through a streamlined referral process, dedicated care coordination and closed-loop communication, physicians receive timely recommendations and ongoing updates while patients benefit from seamless access to the specialists and advanced therapies best suited to their condition.

"Some of the most challenging cerebrovascular conditions don't have a single 'right' procedure—they require the right team," says Badih Adada, MD, Vice Chief of the Neurological Institute for Cleveland Clinic in Florida. "By bringing vascular neurologists, cerebrovascular neurosurgeons, neurointerventional surgeons, neurocritical care specialists and neuroradiologists together from the beginning, we can evaluate every available option and develop a treatment strategy that's individualized for each patient's anatomy, disease complexity and long-term goals."

Multidisciplinary expertise for complex neurovascular disease

The Center for Cerebrovascular Care evaluates patients with a broad spectrum of cerebrovascular and neurovascular disorders, including intracranial aneurysms, AVMs and dural arteriovenous fistulas, cavernous malformations, Moyamoya disease and syndrome, cerebrovascular insufficiency, spinal vascular malformations, chronic subdural hematomas and other complex conditions requiring highly specialized evaluation.

In addition to managing these disorders, the program serves as a regional resource for complex second opinions and structured outside-image review. Advanced imaging—including CTA, MRA, MRI, CT, perfusion imaging, diagnostic cerebral angiography and spinal vascular imaging—is reviewed by a multidisciplinary team to help determine the most appropriate management strategy before treatment decisions are made.

Rather than approaching each case from a single specialty perspective, vascular neurologists, cerebrovascular neurosurgeons, neurointerventional surgeons, neuroradiologists, neurocritical care physicians, neuroanesthesiologists, endocrinologists and rehabilitation specialists collaborate to develop individualized treatment recommendations based on each patient's anatomy, disease complexity and long-term goals.

When should physicians consider referring?

While many cerebrovascular conditions can be managed successfully in the community, certain patients benefit from evaluation at a high-volume multidisciplinary referral center. Physicians should consider referral for patients with:

• Complex, enlarging or difficult-to-treat intracranial aneurysms
• Challenging arteriovenous malformations (AVMs) or dural arteriovenous fistulas (dAVFs)
• Suspected or confirmed Moyamoya disease
• Recurrent transient ischemic attacks (TIAs) or cerebrovascular insufficiency despite optimal medical therapy
• Complex spinal vascular malformations
• Cavernous malformations requiring surgical consideration
• Chronic or recurrent subdural hematomas
• Diagnostic uncertainty or indeterminate cerebrovascular imaging
• Patients seeking expert second opinions before major cerebrovascular intervention

Key Referral Benefits (this section should bea shaded sidebar or highlighted callout, not incorporated into the article

• One point of contact through a dedicated Cerebrovascular Care Coordinator
• Rapid acquisition and review of outside medical records and imaging
• Multidisciplinary case review with individualized treatment recommendations
• Closed-loop communication with timely updates to referring physicians
• Access to comprehensive treatment options, including open microsurgical and minimally invasive endovascular therapies
• Coordinated transition of care back to the referring physician following treatment

Coordinated expertise across the continuum of care

The multidisciplinary approach extends beyond diagnosis and procedural planning. Patients requiring hospitalization benefit from coordinated management that includes neurocritical care, ensuring continuity across emergency treatment, surgery, intensive care and recovery.

"Patients with complex cerebrovascular disease often require seamless transitions between emergency treatment, surgery, intensive care and long-term recovery," says Marc Babi, MD, Director of Neurocritical Care at Cleveland Clinic in Florida. "Our neurocritical care team works alongside vascular neurologists, neurosurgeons and neurointerventional specialists from the earliest stages of treatment to optimize neurologic recovery, reduce complications and ensure patients receive coordinated care throughout every phase of their hospitalization."

The Center for Cerebrovascular Care includes specialized clinical programs focused on complex aneurysm and cerebrovascular surgery, Moyamoya disease and cerebrovascular insufficiency, spinal vascular disorders, skull base vascular lesions and multidisciplinary cranial care, as well as comprehensive second-opinion and advanced image-review services.

Offering the Right Treatment for the Right Patient

One of the program's greatest strengths is its ability to offer the full spectrum of treatment options within a single multidisciplinary practice. Because specialists in microsurgery and endovascular intervention evaluate patients together, treatment recommendations are driven by what is best for the patient—not by a single procedural approach.

Depending on the patient's condition, treatment may include advanced microsurgical procedures such as:

• Intracranial aneurysm clipping
• Arteriovenous malformation (AVM) resection
• Cavernous malformation resection
• Extracranial-to-intracranial (EC-IC) bypass
• Surgical treatment of complex or giant aneurysms
• Decompressive hemicraniectomy
• Microsurgical evacuation of intracerebral hemorrhage
• Treatment of dural arteriovenous fistulas (dAVFs)

For patients who may benefit from minimally invasive techniques, the program also offers:

• Endovascular coiling
• Flow-diverting stent placement
• Stent-assisted or balloon-assisted aneurysm coiling
• Mechanical thrombectomy
• Carotid artery stenting
• Intracranial angioplasty and stenting
• Embolization of AVMs and dAVFs
• Tumor embolization
• Spinal angiography and embolization of spinal AVMs and dAVFs

This breadth of expertise allows physicians across specialties to collaborate on the most appropriate treatment strategy while giving patients access to both established and innovative therapies without requiring referral to multiple institutions.

Simplifying referrals while strengthening physician partnerships

Beyond clinical expertise, the Center for Cerebrovascular Care is designed around the needs of referring physicians. A dedicated Cerebrovascular Care Coordinator serves as the primary point of contact, facilitating rapid acquisition of outside records and imaging, coordinating multidisciplinary review and expediting patient scheduling.

Advanced practice providers and registered nurses support clinical triage, while direct physician-to-physician consultation is available for urgent or highly complex cases. Following evaluation, referring physicians receive timely recommendations, treatment plans and follow-up communication, helping ensure continuity of care when patients return to their local providers.

"Our commitment is not only to delivering exceptional care for complex patients, but also to being a trusted extension of our referring physicians' practices," says Dr. Adada. "From the initial consultation through treatment and long-term follow-up, we prioritize timely communication, collaborative decision-making and a smooth transition back to the referring provider so patients continue receiving coordinated care close to home."

Advancing the Future of Cerebrovascular Care

As cerebrovascular care continues to evolve, Cleveland Clinic in Florida remains committed to advancing the diagnosis and treatment of complex neurovascular disease through multidisciplinary collaboration, innovation and clinical research.

The Center for Cerebrovascular Care provides referring physicians with access to advanced microsurgical and endovascular therapies, sophisticated diagnostic imaging, multidisciplinary expertise and opportunities for participation in clinical research when appropriate. This integrated approach ensures patients benefit from the latest evidence-based treatments while physicians have access to a trusted partner for managing even the most challenging cerebrovascular conditions.

"Innovation is not simply about adopting new technology—it's about bringing together the right expertise to solve increasingly complex clinical problems," says Dr. Adada. "By combining multidisciplinary collaboration, advanced surgical and endovascular techniques, and a commitment to research and education, we continue to expand what's possible for patients with complex cerebrovascular disease while strengthening the partnerships we have with referring physicians throughout the region."