{"id":18295,"date":"2021-06-27T16:02:32","date_gmt":"2021-06-27T08:02:32","guid":{"rendered":"https:\/\/excelmedicalgroup.com\/?p=18295"},"modified":"2022-03-17T18:08:41","modified_gmt":"2022-03-17T10:08:41","slug":"cerebrovascular-surgery","status":"publish","type":"post","link":"https:\/\/www.excelmedicalgroup.com\/en\/case-sharing\/cerebrovascular-surgery\/","title":{"rendered":"Cerebrovascular surgery ( Part 2)"},"content":{"rendered":"

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According to the medical literature, most strokes are caused by congenital or congenital structural lesions in blood vessels in the brain or neck, and a small number by blood or heart disease. The previous issue mentioned how to prevent stroke caused by congenital cerebrovascular lesions, and this issue continues to talk about how to prevent strokes caused by congenital cerebrovascular lesions.<\/p>\n

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The degeneration of cerebrovascular structure is the main cause of congenital cerebrovascular lesions<\/h3>\n

There are many causes of cerebrovascular lesions, most of which are related to the degeneration of blood vessel structure in the brain. By author’s experience, the age of stroke caused by congenital vascular lesions in young people is as low as 28 years old, so stroke is not only affect middle-aged people or elders. Factors such as obesity, high blood pressure and smoking all increase the risk of damage blood vessel structure in the brain, also high cholesterol is also related to family genetics, so some stroke patients have a family history. But in the author’s experience, many stroke patients happened to be the first person in the family, and not necessary without the family history of stroke will never suffer from stroke. In addition, the author has also seen a lot of cases, after several years have had a stroke again.<\/p>\n

The previous paragraph mentions a very important concept, and repeating the relevant paragraph: “Many stroke patients do not have abnormal blood cholesterol levels, so that blood tests can not fully grasp the full picture of the blood vessels condition.\" Because cholesterol is like the fat in our dinner soup, the fat will float on of the soup bowl or adhere to the side of the soup bowl, just like the syringe insert into the soup and not able to extract the grease out, this example is like the body’s cholesterol is attached to the blood vessel wall and will cause vascular lesions, so that the blood vessel wall become block, the blockage leads to ischemic stroke. Cholesterol can also make the walls of blood vessels getting thinner which in turn can lead to an aneurysms and hemorrhagic strokes. The human body is like a car, the government requires the car every year to routinely check parts to see if the overall operation is normal to avoid accidents. Blood tests are like taking car gasoline to check and can’t be reflected the real condition. The extent and safety of internal parts in the car.
\nTo prevent the unexpected occurrence of stroke, not only through blood testing, but to use three-dimensional cerebrovascular angiography to make detailed screening of human parts. Routine examinations include three-dimensional cerebrovascular angiography, where neurosurgeons can identify congenital problems before the patient develops symptoms, and then decrease the risk of stroke in the future.<\/p>\n

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Case one: A 39-year-old healthy woman<\/p>\n

Miss Huang, 39, has always been in good health and undergoes simple blood test every year, and everything is fine. Recently, she has a friend died of a hemorrhagic stroke with no signs of headache dizziness, normal blood pressure, the family has no history of stroke.\u00a0 Miss Huang want to actively rule out the risk of future stroke, so she want to have the physical examination thru seeking advice from a neurosurgeon. Doctors advised her to have a magnetic resonance 3D brain and blood vessel angiography screening. The MRA of brain showed that Miss Huang’s right brain blood vessel had an aneurysm of one to two millimeters. According to the medical literature and the author’s experience, even a very small aneurysm burst will lead to a serious risk of stroke under the brain membrane, the risk is an average of 1 to 2% per year. Miss Huang’s risk of aneurysm rupture could be 50 to 100%. After careful consultation with her family, Miss Huang underwent half an hour of minimally invasive intravascular stent therapy. Cerebrovascular surgery only need to go through a pinhole wound in the thigh, using 3D space cerebrovascular angiography and route, safely and accurately implanted a stent that strengthens the cerebrovascular vessels and stops blood from flowing into aneurysms to prevent future severe hemorrhagic strokes.<\/p>\n

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Case 2: 52-year-old man<\/p>\n

Mr. Ho, 52, with a strong build body who doesn’t smoke or drink and eats very healthy. He turned to a neurosurgeon for help because of sciatic nerve pain, and the doctor suggested that he should have a MRI for his of the lumbar vertebral and he should also be screened for stroke by magnetic resonance three-dimensional cerebrovascular angiography. Magnetic resonance results show that Mr. Ho’s lumbar disc protrusion causes sciatic nerve pain, but the situation is not serious, can take medicine or do physical therapy, chiropractic conservative treatment. But the three-dimensional angiogram of stroke screening showed that Mr. Ho had a 4mm cerebrovascular middle aneurysm of the blood vessels in his right brain, and that if the aneurysm burst it could cause a severe hemorrhagic stroke, and that the risk of aneurysm rupture was an average of 1 to 2 percent per year, meaning that Mr. Ho had a 30 to 60 percent chance of rupturing in the next 30 years before he was 82.<\/p>\n

Mr. Ho took the advice of his doctor to undergo minimally invasive cerebrovascular surgery to prevent stroke. Since aneurysms are located in the position of the middle artery branch, normal minimally invasive intravascular stent therapy surgery might have the risk lead to the embolism of blood vessels, so the author recommended that Mr. Ho do craniofacial surgery, that is, microscopic minimally invasive cerebrovascular surgery aneurysm clamping surgery. During the three- to four-hour operation, the neurosurgeon carefully separated the nerves and cerebrovascular vessels under a microscope, then used titanium clips to clamp the aneurysm located in the middle artery branch, and the timing bomb in Mr. Ho’s brain was removed, changing the fate of future hemorrhagic strokes (see figures I, II, III). The day after the operation, Mr. Ho went home to rest and continued to receive conservative treatment for sciatic nerve pain for half a year.<\/p>\n

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Exercise, healthy eating, no smoking, no alcohol, regular blood pressure checking and electrocardiogram testing alone can only show and cannot completely prevent the normal degeneration of cerebrovascular structure, even a healthy and athlete person will have a stroke.<\/p>\n

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Author<\/strong><\/span><\/p>\n

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DR. PETER K.H. PANG<\/strong><\/p>\n

MBBS (HK), FCSHK, FRCS (Edin), FHKAM (Surgery)<\/span><\/p>\n

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