A stroke can be an extremely scary event, sometimes requiring emergency surgery. Although surgery after a stroke is not uncommon, the many unknowns can be overwhelming for both survivors and their loved ones. The specific surgery you may receive depends largely on the type of stroke you experienced and the location of the stroke in the brain. After surgery, you will begin a personalized stroke rehabilitation program to help you regain mobility and independence.

Not every case of stroke will require surgery. However, we hope to help you better understand the different stroke surgery interventions you may encounter. First, let’s discuss the two main types of stroke. Next, we’ll discuss some surgical options that help stop or stop tissue damage in the brain. Finally, we will explain the next steps in your post-surgery recovery process.

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Hemorrhagic stroke and ischemic stroke

Broadly speaking, stroke refers to a disruption of normal blood flow in the brain. This disruption leads to cell death and tissue damage in the brain. There are two main types of stroke, known as hemorrhagic stroke and ischemic stroke. The two types of stroke are very different and are also treated differently.

AND hemorrhagic stroke occurs when an artery in the brain ruptures or ruptures. Most often, these are hemorrhagic strokes caused by hypertensionor high blood pressure. This type of stroke often affects the basal ganglia, although a hemorrhagic stroke can affect many other areas of the brain. A hemorrhagic stroke causes bleeding in the brain, resulting in increased pressure and swelling. This bleeding is called intracerebral hemorrhage or hematoma.

Some ischemic stroke is caused by a blockage of an artery in the brain. This causes the area of ​​the brain supplied by this artery to lose blood supply. As a result, brain cells do not receive the oxygen-rich blood they need to function, which causes tissue damage. Around 87% strokes are ischemic and are caused by a blood clot from somewhere else in the body. Often these clots (or embolisms) they begin in the heart and journey to the brain. Although various arteries can be affected, the most common are the middle cerebral artery (MCA) and the anterior cerebral artery (ACA).

Timely treatment = better results

Detecting a stroke early is extremely important and can help limit tissue damage in the brain. Learning about the different warning signs of a stroke can help you or a loved one get treatment for a stroke quickly. Stroke symptoms may include facial drooping, weakness in an arm or side of the body, slurred speech, or a sudden, severe headache. If you or a loved one exhibits these symptoms, get emergency help immediately.

In the event of a stroke, prompt treatment is necessary to limit the damage to brain tissue. When you arrive at the hospital, the medical team will determine what type of stroke you are experiencing. This diagnosis process will likely involve a variety of tests and different types of imaging. Once the type and location of the stroke are determined, surgery may be necessary.

Hemorrhagic stroke surgery

Treatment for hemorrhagic stroke focuses on 3 goals. These goals are to stop the bleeding, to resolve hematoma (accumulation of blood outside the blood vessels) and relieving intracranial pressure (pressure in the skull). In some cases, these goals can be achieved with conservative interventions. With medications or other therapies, hematomas can sometimes be cured without surgical intervention. However, increased pressure in the brain and impaired blood flow may dictate the need for surgery after a hemorrhagic stroke.

Depending on the severity of the stroke and the patient’s condition, surgery is often performed on the stroke first 48 to 72 hours. Sometimes, however, doctors have to wait longer if the patient’s condition needs to stabilize before surgery. To help you understand what you may encounter, let’s look at some of the common types of surgery used to treat hemorrhagic stroke.

Types of hemorrhagic stroke surgery

• Craniotomy. If the hematoma is large and causing significant pressure, the neurosurgeon will remove part of the skull to drain the hematoma. This surgery allows the brain to bulge beyond the confines of the skull, reducing intracranial pressure and preventing further damage. Doctors can then operate directly on the brain to remove the hematoma and repair the blood vessel before replacing the bone flap.
• Craniectomy. Like a craniotomy, a craniectomy involves removing a piece of the skull to relieve pressure and allow access to the brain. However, the bone flap cannot be replaced immediately. Instead, the surgeon may replace the bone flap later when the swelling subsides. This often happens a few weeks after the first surgery.
• External ventricular drainage. Placement external ventricular drainage (EVD) is a common procedure after hemorrhagic stroke. This involves inserting a small catheter into the brain to drain excess fluid. It is less invasive than other surgical options and may help reduce intracranial pressure caused by stroke.
• Endoscopic evacuation. This is another minimally invasive surgery used to treat hemorrhagic stroke. During this surgery, a small hole is drilled in the skull and a small camera (endoscope) is used to help the neurosurgeon reach and drain the hematoma.
• Stereotactic aspiration. A CT scan is used to locate the hematoma before a small hole is drilled into the skull. The hematoma is then manually drained using a special suction tool.
• Surgical haircut. During a craniotomy, the surgeon may place surgical clamp or coil to help repair a damaged artery. This may stop active bleeding and prevent future hemorrhage.

Ischemic stroke surgery

As we mentioned earlier, the blockage responsible for ischemic stroke limits blood flow to the brain. The longer it goes untreated, the more damage to brain tissue may occur. This may increase the severity of a stroke and lead to more widespread side effects.

Ischemic strokes can often be treated with clot-busting drugs, e.g tissue plasminogen activator (tPA) or aspirin. TPA can be administered within 3 hours of symptom onset. When administered, these medications help dissolve the clot and restore blood flow to the brain. However, in some cases of ischemic stroke, surgery may be necessary to remove the clot.

The surgery most commonly used to treat ischemic stroke is mechanical embolectomy or thrombectomy. During this procedure, a blood clot in the brain is removed using a specialized clot removal device or stent. This device is inserted into the artery using a catheter to reach the clot. This special catheter is usually inserted into the groin, making the procedure much less invasive than brain surgery. Once the clot is secured, the device is then removed and the clot removed with it.

To help you visualize this procedure, here is a video showing how mechanical embolectomy or thrombectomy works:

Postoperative recovery

There is usually recovery after intensive stroke surgery such as a craniotomy 6-8 weeks. During this time, it is important to follow the guidelines provided by your neurosurgeon. This includes information about incision care, precautions for daily activities, and warning signs of infection or hemorrhage. Additionally, you will be closely monitored by medical staff to ensure that no additional complications occur.

After other surgeries, the initial post-operative recovery period may be shorter. For example, a person who has undergone mechanical embolectomy surgery after an ischemic stroke may be able to walk the next day. Regardless of what surgery you undergo, it is important to follow the instructions of your healthcare professional to maximize your results.

Once the patient’s health condition is stable, it will be extremely important to start rehabilitation, which will help regain functions lost as a result of the stroke. Stroke recovery treatments include physical therapy, occupational therapy, and speech therapy. Whether you participate in intensive inpatient stroke rehabilitation after surgery or are discharged home, it is important to remain consistent with your exercise program. This will allow you to recover as much as possible and increase your independence.

Stroke surgery: evaluating your options

After a stroke, surgery may be necessary to restore normal blood flow to the brain. Although less invasive treatments can be used in some cases, sometimes surgery is necessary to stop tissue damage in the brain and save the patient’s life. The type of surgery required depends on the type, severity and location of the stroke. For example, the two main types of stroke (hemorrhagic and ischemic) require different types of surgery to restore normal blood flow to the brain.

If the stroke is caused by a ruptured artery (hemorrhagic stroke), neurosurgeons may perform a craniotomy to open the skull and relieve intracranial pressure. Additionally, less invasive procedures such as external ventricular drainage or stereotactic aspiration may be used to drain the hematoma.

If the stroke is caused by a blood clot (ischemic stroke) and cannot be treated with medications, surgery may be necessary. A mechanical embolectomy or thrombectomy may be performed to remove the clot using a catheter and clot removal device. Removing the clot allows normal blood flow to the brain to be restored.

Each type of surgery comes with risks and benefits, so it’s best to discuss your unique situation with your medical team. However, because stroke is a medical emergency, some decisions are made in high-pressure situations where there is no time to discuss the pros and cons. When a stroke happens, you often have to trust that your medical team will make the best decision possible for you or your loved one.

While life after a stroke can seem overwhelming, there are many tools to help you on your journey. Once your health condition is stable, the rehabilitation process will begin. Stay consistent with your rehabilitation program and continue working to achieve your unique post-surgery stroke goals.