The role of surgery in stroke treatment and prevention

Dan Heffez, M.D., Neurosurgeon, Columbia St. Mary’s Hospital

Posted: Sept. 1, 2006

A stroke occurs when blocked or damaged arteries prevent blood from reaching the brain. When the brain’s blood supply is cut off, its tissue begins dying within minutes.

As a result, a stroke victim should be evaluated and treated as soon as possible after a stroke occurs (or is thought to have occurred). Early treatment helps increase the chance of survival and the quality of the recovery.

The form of treatment, however, depends on the type of stroke suffered. Some strokes are treated medically (with drugs) while others are treated surgically. Sometimes surgery is preventive of future strokes; other times it repairs damaged of malformed blood vessels.

For example, an ischemic stroke is caused by a blocked blood vessel. This blockage could occur in the blood vessels of the brain or in the larger carotid artery of the neck. A neurosurgeon typically does not operate on this type in the early stages of the stroke. Instead, other specialists treat the condition with a clot-busting drug. This drug, known as tissue plasminogen activator (tPA), works best when administered within the first three hours after a stroke occurs.

Sometimes a neurosurgeon will perform a preventive procedure to remove plaque from the walls of the carotid artery, enabling the blood to flow more freely. This is known as a carotid endarterectomy. Plaque buildup is caused by a condition known as atherosclerosis or hardening of the arteries.

A hemorrhagic stroke is another type of stroke. It has no warning signs and is caused when a weakened blood vessel in the brain suddenly ruptures. Escaping blood can damage the surrounding brain tissue. Hemorrhagic stroke is frequently associated with elevated blood pressure. In such cases, the best way to prevent a hemorrhagic stroke is to keep your blood pressure under control.

Although it’s rare, a neurosurgeon may sometimes be called in to remove the blood clot resulting from a hemorrhagic stroke in an effort to hasten recovery. Without surgery, the clot eventually will dissolve on its own.

A neurosurgeon is also called in to intervene when a hemorrhagic stroke has resulted from an aneurysm, which is a weakened area in a blood vessel wall. A neurosurgeon will repair this damaged area in an attempt to prevent the problem from happening again. However, the surgery cannot undo damage from the original bleeding.

A hemorrhagic stroke can also be caused by congenital abnormal connections between the arteries and veins in the brain, which are known as arteriovenous malformations. Because these blood vessels tend to be weaker than normal, they are more inclined to burst and cause bleeding in the brain. Surgery is generally required to remove these abnormalities.

Though rare, a patient may require a surgical bypass (similar in principle to a heart bypass) when a blockage prevents blood from reaching part of the brain. In this procedure, a blood vessel from the scalp is connected to a blood vessel of the brain to circumvent the blockage.

An early warning of stroke is a transient ischemic attack (TIA). These are considered mini-strokes or warning strokes in which blood flow is cut off from a portion of the brain for a brief period of time. The symptoms usually last 1 hour or less. While a TIA is reversible, it is considered serious and should be quickly evaluated by a physician. About 30 percent of stroke patients have a history of TIAs prior to progressing to a completed stroke.

Because it is important to seek help quickly after a stroke occurs, it is important to recognize symptoms of a stroke. These may include a sudden numbness in the face or on one side of the body; sudden nausea or vomiting; difficulty speaking or understanding spoken words; impaired vision; difficulty swallowing, dizziness or loss of balance, brief loss of consciousness; partial paralysis; and/or a sudden and intense headache.

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