Cerebrovascular surgery ( Part 1) - 彭家雄 脑神经外科专科医生

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Cerebrovascular surgery ( Part 1)

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Cerebrovascular surgery is a special surgery done by neurosurgeons. The surgery is basically for stroke prevention, emergency life saving and stroke rehabilitation, and is also used for stroke prevention and treatment. Based on past clinical experience and cases, the author will explain the stroke “Prevention" to readers, and also talk about the public’s misunderstanding of stroke prevention and explain the congenital cerebrovascular lesions.

 Stroke prevention and stroke screening is important to avoid stroke. The risk of stroke is often underestimated by the general public, and there are misunderstandings about the prevention of stroke.

Exercise, diet, avoid fatty food and regular blood test can not completely prevent stroke: many people think that by exercise alone, healthy diet, do not smoke or drink, prevention and treatment of three high contents (i.e., high blood pressure, high blood sugar, high cholesterol), or simple electrocardiogram, blood test on blood sugar and cholesterol, can effectively prevent stroke, which overestimates the effectiveness of the above-mentioned basic prevention, but also underestimates the causes of stroke. Most strokes, mainly due to congenital or congenital lesions in the brain or neck vessels, are structural problems. However, the very basic health prevention, can only reduce and slow down the chance of future occurrence of vascular lesions, but did not specifically find out the existed congenital, or vascular lesions.

Based on my  observation of many stroke patients, their blood cholesterol levels are normal, the blood test does not completely reliable, because cholesterol is like the fat in the dinner soup, fat will float on top of soup and adhere to the wall of the soup bowl, we cannot use syringe in the soup to draws up the grease, same as the body’s cholesterol is also attached to the blood vessel wall, will cause vascular lesions, and the blood vessel wall is very narrow, blockage leads to ischemic stroke. Cholesterol can also make the walls of blood vessels thin, which in turn can lead to a hemorrhagic stroke caused by an aneurysm.

The human body is like a car, the government requires the car every year to routinely check the car parts to see if the overall operation is normal. Blood test, like gasoline from a car, does not reflect the extent and safety of the internal parts of the car. In order to prevent the occurrence of stroke accidents, not only do blood test, MRI scanning of the cerebrovascular angiography is also important.

 

Stroke, regardless of age, is not just happen on elderly or middle-aged, therefore we need to do cerebrovascular screening for stroke prevention:

Talk about congenital cerebral venous malformations.Congenital Cerebral Arteriovenous Malformation. Everyone thinks that stroke only affected with age, but this is wrong, and even children of any age have a chance of having a stroke. Stroke is caused by cerebrovascular disease, and each of us, regardless of age, has the chance to develop congenial or congenial cerebrovascular disease. Strokes in children and adolescents can be hemorrhagic strokes caused by congenital cerebral venous malformations.

 

 

 

 

 

Case: Four-year-old child

The four-year-old boy, born with a healthy and normal body without any symptoms, one day shopping with his mother suddenly felt a severe headache, and then suddenly unconscious. Sent to the hospital confirmed to be congenital cerebral venous malformation hemangioma burst caused by severe hemorrhagic stroke, although he was saved  but even after many years of treatment can not reverse the permanent damage to the brain, today the child is still suffering from severe disability, need long-term care.

Case: Women during pregnancy

Two 15- and 16-year-old healthy girls, and a 39-year-old healthy woman,  no headache symptoms, three cases in the early, middle and late stages of pregnancy, suddenly suffered from severe cerebral hemorrhagic stroke, severe headache after a sudden coma shock, after emergency brain surgery to remove blood clots and reduce intracranial pressure, two girls and their children fully recovered without any sequelae. The 39-year-old woman, even though can survive however was totally disable and laid in bed for five years in hospital before dying.

Case: Prevention of stroke

Two mens, a 16-year-old and a 56-year-old man, underwent a thorough physical examination without any signs, and MRI of cerebrovascular angiography showed that both men’s brains had congenital cerebrovascular venous malformations, after a period of observation and conservative treatment of a specialist, by using minimally invasive intravascular therapy plus radiation therapy, malformed blood vessels were effectively treated, and the patient’s innate brain bomb was removed, reducing their chances of future haemorrhagic strokes.

From the previous case experience of cerebrovascular surgery, we know that cerebral venous malformation hemangioma, a detailed MRI imaging of cerebrovascular angiography screening to avoid future tragedies.

 

笔者

彭家雄 脑神经外科专科医生

香港大学内外全科医学士
英国爱丁堡皇家外科医学院院士
香港外科医学院院士
香港医学专科学院院士(外科)


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