Neurosurgery and Stroke: Effective Pathways and Surgical Interventions Explained

By Dr Puneet Nandrajog, Consultant Neurosurgeon, Bukit Tinggi Medical Centre (BTMC)

Regular check-ups and awareness of risk factors are crucial for early intervention. A healthy lifestyle is the most effective way to reduce your risk of stroke.

Every year, 15 million people worldwide experience a stroke, with 5 million resulting in death and another 5 million facing permanent disability. In Malaysia, the situation is also alarming. The National Stroke Registry recorded over 47,911 stroke cases in 2019, meaning approximately 130 people experience a stroke every day. Without preventive action, one in four Malaysians may suffer a stroke by 2040.

Stroke is a medical emergency that can change lives in an instant, but timely diagnosis, treatment, and neurological intervention can significantly improve outcomes and quality of life. Early recognition and prompt treatment are crucial when dealing with strokes, especially when surgical interventions are required. Acting quickly can drastically improve a patient’s recovery and long-term quality of life.

This highlights how crucial early detection is in managing strokes effectively, particularly when surgical options are necessary to reduce damage and improve recovery outcomes. Timely neurosurgical intervention, whether it is for ischemic or hemorrhagic stroke, can mean the difference between a full recovery and long-term disability.

Discerning stroke types

Strokes are categorised into two main types, ischemic and haemorrhagic. Ischemic strokes, which make up about 87% of cases, happen when a blood vessel supplying the brain becomes blocked, usually by a clot. This blockage prevents the brain from receiving the blood and oxygen it needs, leading to cell death in the affected areas.

Haemorrhagic strokes, on the other hand, occur when a blood vessel in or around the brain ruptures, causing bleeding that damages brain tissue. The pooling of blood increases pressure inside the skull, causing further damage to brain cells. The type of stroke significantly influences the treatment strategy, as ischemic and haemorrhagic strokes require very different interventions. Early and accurate diagnosis is crucial, as it helps guide the appropriate treatment approach, whether it is clot removal for ischemic strokes or surgical intervention for haemorrhagic strokes.

Recognising stroke symptoms
Recognising the symptoms of a stroke swiftly and accurately is critical, as it can dramatically improve the outcome for the patient. Stroke symptoms often appear suddenly, and the most common indicators include a sudden weakness or numbness, particularly on one side of the body, slurred speech, facial drooping or asymmetry, and a loss or reduction in consciousness. Other signs may include confusion, difficulty understanding speech, vision problems in one or both eyes, and difficulties with coordination or balance. Recognising these symptoms early is key, as stroke is a race against time.

The acronym FAST – Face drooping, Arm weakness, Speech difficulties, and Time to call emergency services, serves as an essential guide in recognising these signs and taking immediate action. When someone is having a stroke, every second matters. The sooner we can start treatment, the more brain function we can preserve.

When it comes to strokes, time is brain. Every minute counts, as early intervention can drastically reduce the extent of brain damage. Prompt recognition and swift action in getting the patient to a hospital can be lifesaving, preventing more severe outcomes such as long-term disability or even death.

Risk factors for stroke

Several factors significantly increase the likelihood of experiencing a stroke:hypertension, dyslipidemia, diabetes, and smoking, which can all damage blood vessels. Cardiac conditions, like atrial fibrillation, as well as excessive alcohol consumption and a sedentary lifestyle, further raises the risk.

Recent trends also show a rise in strokes among younger populations in Malaysia, emphasising the need for increased awareness and preventive actions. Managing these risk factors through regular health check-ups and lifestyle changes is crucial in reducing the risk of stroke.

Diagnostic process

Once a stroke is identified, the diagnostic process must be initiated immediately to determine the type of stroke and the best treatment approach. The first line of imaging is usually a CT scan, which can rapidly detect a haemorrhagic stroke by showing bleeding in or around the brain. A CT scan is our first tool in emergencies because it is fast and readily available, giving us crucial information about whether a stroke is haemorrhagic.

However, for ischemic strokes, where a clot blocks blood flow to the brain, more detailed imaging is often needed. MRI scans offer superior detail, allowing for the detection of smaller areas of ischemia that may not
be visible on a CT scan. CT scans offer a quick look into haemorrhagic strokes, but an MRI is crucial for identifying ischemic strokes early. It helps us make informed decisions on the appropriate course of treatment, particularly in smaller or more complex cases.

These diagnostic tools are essential in quickly assessing the severity and location of the stroke. Thus, guiding the medical team toward the most effective treatment path, whether it is clot-dissolving drugs, surgical intervention, or other therapies.

Once a stroke is diagnosed, the next step is determining the most effective treatment. Neurosurgery plays a pivotal role in this process, especially for severe cases.

Neurosurgery in stroke management

Neurosurgery plays a vital role in both the acute phase of stroke treatment and in long-term recovery. The primary treatment for ischemic strokes is thrombolysis, which involves injecting a medication into a vein to dissolve the blood clot that is blocking blood flow to the brain. Another option for treating ischemic strokes is a thrombectomy, a procedure that may be performed with or without angioplasty to remove the clot directly from the blocked artery. In cases of large ischemic strokes, a decompressive craniectomy may be necessary to relieve pressure on the brain and prevent further damage.

One of the most critical treatments for ischemic stroke is thrombolysis, which involves administering clot-dissolving drugs. However, there is always a risk of intracranial haemorrhage, which might necessitate further surgical intervention.

For haemorrhagic strokes, treatment can be divided into non-surgical and surgical approaches. Non-surgical treatment primarily focuses on controlling blood pressure and stabilising the patient, while surgical options vary depending on the type of haemorrhagic stroke. These procedures may include decompressive craniotomy to relieve pressure in the brain, removal of a blood clot, clipping of an aneurysm, or draining excess fluid from the brain.

Each intervention is tailored to the individual patient’s condition, emphasising the importance of restoring blood flow and reducing pressure on the brain.

Post-stroke rehabilitation; reclaiming quality of life

After the immediate danger of a stroke has passed, rehabilitation becomes a critical part of recovery. Stroke patients may need physiotherapy, speech therapy, and occupational therapy to regain lost functions and prevent complications such as bedsores and pneumonia.

Rehabilitation is as essential as the treatment itself. Starting rehab early and continuing it diligently can make all the difference in a patient’s quality of life.

Prevention remains the best cure. Maintaining a healthy lifestyle – regular physical activity, a balanced diet, and avoiding smoking and excessive alcohol consumption can significantly reduce the risk of stroke. Managing conditions like hypertension, high cholesterol, and diabetes is also vital.

AI, other emerging treatment strategies

Recent advancements in stroke-related neurosurgery have transformed treatment options, particularly through the adoption of minimally invasive procedures. These techniques reduce complications and promote quicker recovery times. Image-guided navigation and technological advances in neurosurgery are key innovations, offering surgeons greater precision and control. Many of these technological advances in neurosurgery are game changers, allowing us to operate more precisely and safely, often through a keyhole incision. It is less invasive, which means quicker patient recovery.

Additionally, artificial intelligence (AI) enhances diagnostic accuracy and treatment planning by rapidly analysing imaging data and identifying stroke patterns earlier than traditional methods. The integration of AI and robotics into stroke care is expected to continue evolving, further improving patient outcomes and surgical precision.

In the next few years, we expect significant advancements in neurosurgery and stroke treatment. AI and robotic technologies are set to revolutionise how we diagnose and treat stroke patients, offering greater precision and improved outcomes

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