Role of Neurosurgery in Stroke Management

Outline:

Stroke is a medical condition resulting from a lack of circulation through the brain resulting in the death of brain cells. The brain cells once dead are never regenerated.

The two main types of stroke are:

• Ischemic, due to lack of blood flow, and
• Hemorrhagic, due to bleeding in a specific part of the brain

Both types of strokes result in the nonfunctioning of certain bodily activities. The recovery usually is extremely gradual based on the extent of damage due to stroke.

Considering Surgery after a Stroke:

As complicated as it sounds and it is the surgery is a practicable option after a stroke. Surgery is recommended in non-medically manageable cases or medical emergencies, the results of which are extremely convincing. You can always read about it and speak to your neurosurgeon before being able to decide for your loved one. Let us help you with the former.

Surgical Management in Stroke:

1. Mechanical Embolectomy – An embolus is a dislodged thrombus that is blocking circulation. It is an x-ray guided procedure in which a small plastic tube is inserted through an artery in the leg to the brain. The blockage is then flushed or reclaimed. This is a minimally invasive procedure that takes about 2 to 3 hours. Moreover, the procedure can take place within 8 to 12 hours of appearing of signs. The decision of this surgery should be made by then to encourage good results. Delaying the procedure may cause unnecessary complications.
2. Hemicraniectomy – In case of severe stroke, the entire blood flow to the brain is hampered resulting in huge swelling. In that case, half of a person’s skull is removed to provide space to swollen tissue. The skull is kept frozen preserved until the swelling subsides and put back in place once things fall in place. This operation is considered in case of medical emergencies and severe strokes, therefore the recovery even post-procedure depends on the extent of the damage.
3. Carotid Angioplasty and Stent – It is recommended to those at a greater risk of having a stroke or have had a transient ischemic attack. The carotid artery supplies blood to the brain. In this procedure, a balloon is inserted and inflated into the artery widening it and preventing any further arteriosclerosis.

Sometimes, a stent is also inserted following the balloon to keep it in shape even when the balloon is in place. Both are minimally invasive procedures.

4. Carotid Endarterectomy – Traditional open surgery where the blockage is removed and the artery is widened. Good blood flow is assured before closing. This procedure can be done both preventively and curatively.
5. Cerebral Revascularization (Bypass Surgery) – A new artery is connected to the part where the supply is lacking instead of carotid or blocked artery. The normal function of the brain is restored after the surgery. This is a choice of treatment as prevention or posts initial transient ischemic attack.
6. Aneurysm Clipping and Coil Embolization – An aneurysm is a balloon-like bulge formed as a result of the weakening of the arterial wall. This prevents blood from flowing through the brain causing a stroke.

The aneurysm is cut and the artery clamped thus reinstating the blood flow in case of aneurysm clipping. The person operated needs to stay in an intensive care unit postoperatively for a few days until healing happens.

Coil Embolization is much like mechanical embolization wherein a coil instead of a balloon, a coil is transferred into the Aneurysm forming a blood clot retarding blood to get into it. This will prevent it from bursting.

Stroke affects not a person but a family. You should be well aware of all your options and how each one adds quality to the life of you and your loved one.

Dr. Anurag Saxena, Senior Consultant – Neurosurgery, Spine Surgery, Narayana Superspecialty Hospital, Gurugram