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Stroke Surgical Treatment

A stroke occurs when blood supply to the brain is interrupted or there is bleeding in the brain. Within minutes, brain cells begin to die. It is urgent to get emergency care at the first sign of a stroke. Early treatment saves many lives and reduces the effects of stroke.

The warning signs of stroke are:

  • Numbness, weakness, or paralysis of the face, arm, or leg (on one or both sides of the body)
  • Vision that suddenly blurs or decreases (in one or both eyes)
  • Trouble speaking or understanding
  • Dizziness, loss of balance, or a fall that is unexplained
  • Difficulty swallowing
  • Sudden, severe, unexplained headache
  • Sudden confusion

For any of the warning signs of stroke, call 911 right away, and get to a stroke center for emergency care.

Types of surgery

After receiving emergency care, some stroke patients may be helped by surgery.

 

For Strokes from Blockage

Most strokes occur when a blood vessel in the brain is blocked and blood flow stops. This type of stroke is called an ischemic (iss-KEYmik) stroke. The blockage may be caused by a blood clot, and severe brain swelling may result. Life-saving surgery may be necessary to remove the clot and the brain tissue that has died from lack of oxygen.

A blockage also can occur when the artery itself narrows. A harmful fatty deposit, called plaque (PLAK), may build up in an artery and then block it. Sometimes clots form, which can then break off and travel to block another artery in the brain. Some patients can be helped by a procedure called angioplasty (AN-jee-oh-plass-tee). During the procedure, a tiny balloon at the end of a long, thin tube is pushed through the artery to the blockage. When the balloon is inflated, it opens the artery. In addition, a mesh tube may be placed inside the artery to help hold it open. The tube is called a stent. The procedure usually requires a hospital stay of several days.

For Blockage in the Neck

The main arteries in the neck help supply the brain with blood. They are called the carotid (kuh-RAW-tid) arteries. When patients have a serious blockage in these arteries, surgery may be done to prevent a stroke or a ministroke, which is also called a TIA. The operation is called a carotid endarterectomy (en-dar-ter-EK-tuh-mee).

This procedure cleans out and opens up the narrowed artery. During the operation, the surgeon scrapes away plaque from the wall of the artery. Blood can then flow freely through the artery to the brain. A patient usually stays in the hospital 2 to 3 days for this operation.

For Strokes from Altered Blood Flow

Blood flow to the brain may decrease temporarily in some patients. This is called a ministroke
or a TIA, which stands for transient (TRANS-yent) ischemic (iss-KEY-mik) attack. While the brain is not getting enough blood, it cannot work properly. Patients who have TIAs get symptoms for a short time that make it difficult for them to function.

Bypass surgery may be advised for some patients who continue to have TIAs. During the operation, an artery on the outside of the scalp is re-routed to the part of the brain that is not getting enough blood flow. When blood flow is restored, the brain works normally, and the symptoms disappear. The hospital stay for this type of bypass surgery is about one week.

For Strokes from Bleeding

Bleeding in the brain causes some strokes. These strokes are called hemorrhagic (HEMer-RAJ-ik). The bleeding may occur when a weakened blood vessel leaks or bursts. This is called an aneurysm (AN-your-izm). When an aneurysm occurs, the weakened artery may become like a balloon filled with blood. Patients usually describe an aneurysm as the worst headache of their life.

There are several types of surgery to repair an aneurysm. A clip may be placed across the
neck of the aneurysm (like a clip at the end of a balloon) to stop the bleeding. A newer approach
is to thread a long, thin tube through the artery that leads to the aneurysm. Then a tiny coil is fed through the tube into the aneurysm “balloon” to fill the space and seal off the bleeding. Based on the type of surgery, the hospital stay ranges from several days to a week or longer.

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