SURGICAL TREATMENTS FOR HEMORRHAGIC STROKE PATIENTSCGMH Department of Neurosurgery PoChuan, Hsieh 林⼝口⻑⾧長庚 神經外科 謝博全

DEFINITION

“A STROKE, sometimes referred to as a cerebrovascular accident(CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain.” -wikipedia

“A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damange to the brain tissue.” -WHO, stroke/cerebrovascular accident

SURGICAL PRINCIPLE

Treatment goal:

Prevent rebleeding

Correct 2nd injury - mass effect / hydrocephalus

COMMON SITE FOR ICH

Schmidek et al: Operativve neurosurgical techniques. 1st ed. 1982

50%

15%10-15%

10%10-20%

ICH SCOREFEATURE FINDING POINTS

GCS3-4 25-12 113-15 0

AGE >80 1<80 0

LOCATION infratentorial 1supratentorial 0

VOLUME >30cc 1<30cc 0

IVH yes 1no 0

ICH SCORE 0-6

ICH SCORE 30D MORTALITYY

0 0%

1 13%

2 26%

3 72%

4 97%

5 100%

6 =100%

Hemphill J C, Stroke 32 (4): 891-7, 2001

INTRACEREBRAL HEMORRHAGE (SUPRA-/INFRA-TENOTORIAL)

SUBARACHNOID HEMORRHAGE (WITH ANEURYSM)

ARTERIOVENOUS FISTULAE

ARTERIOVENOUS MALFORMATION

*ICH due to venous hypertension

*Cavernous hemangioma

INTRACEREBRAL HEMORRHAGE

14 y/o boy, collapse during basketball playing, M5, bradycardia

PREVIOUSLY CLIPPED ACOM ANEURYSM

25 y/o M, previous hx of a-com aneurysm at 21 y/o collapse and seizure while dating

M2->M5-6 1 day after EVD insertion

preop

postop angio

RECURRENT EMBOLIZED ACOM ANEURYSM

CTA at OPD

frontal ICHIVH

48 y/o M, previous hx of a-com aneurysm s/p embolization Recurrent explosive headache

artifact

recurrent sac

MYCOTIC ANEURYSM

DURAL ETHMOIDAL A-V FISTULA

Case 1 50 y/o M

CTA

AngiographyRt ICA

Lt ICA

Postop. Angio.

Case 2 31 y/o M

ARTERIOVENOUS MALFORMATION

8 y/o girl, seizure - right hands weakness/central facial palsy

Postoperative Images

32 y/o M, incidental findings

Thanks for Attention, and Happy New Year