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Cross Post: Neurosurgeons Play a Pivotal Role in the Treatment of Stroke

schirmer6196Today’s post originally appeared on the AdvaMed’s Life Changing Innovation website. The post addresses the all-important topic of the how neurosurgeons play a pivotal role in the treatment of stroke.

Neurosurgeons Play a Pivotal Role in the Treatment of Stroke
Clemens M. Schirmer, MD, PhD
Joint American Association of Neurological Surgeons/Congress of Neurological Surgeons Cerebrovascular Section

Stroke is the fourth leading cause of death in the United States and a significant public health problem world-wide. In the US, it is also the number one cause of disability. According to the Centers for Disease Control and Prevention (CDC), every year, more than 795,000 people in the US have a stroke. It’s for this very reason that Neurosurgeons believe it’s critical to take the time to learn the signs and symptoms of stroke during May, which is National Stroke Awareness Month.

Unlike many other disease processes, with stroke the onset of symptoms is sudden and unpredictable, just like a heart attack. Aggravating this problem even more, patients suffering from a stroke cannot voice their symptoms – letting valuable time go by until stroke is recognized critical intervention can be initiated.

Whether the stroke is hemorrhagic (bleeding into the brain) or ischemic (blockage of a vessel causing loss of oxygen to the brain) neurosurgeons play a central role in treating stroke patients. In most hospitals, neurosurgeons work collaboratively with a larger team that will meet a stroke patient in the hospital and provide the unique surgical skills often required as part of treatment. During neurosurgical training the evaluation and treatment of stroke – both the acute treatment and secondary prevention – is an area of focus so that neurosurgeons become experts in treating stroke and its symptoms. Some neurosurgeons also receive additional specialized training in Cerebrovascular surgery, which includes highly technical expertise in endovascular, interventional or open surgical techniques uniquely geared towards the treatment of patient with stroke.

Technical advances have allowed caregivers and Neurosurgeons in particular to deliver care more efficiently. These include systems of care that employ tele-radiology or distance assessment of critical images to drive expert-level decisions at a local level. Another example are endovascular devices such as stentrievers, suction aspiration devices, and clot retrieval devices that allow rapid restoration of blood flow in blocked arteries in the brain.  For hemorrhagic stroke, technological development of endoscopic devices have aided neurosurgeons in removing intracerebral or intraventricular hematomas.

Once these interventions provide the optimal setting for recovery, neurosurgeons collaborate to insure the specialized after care and secondary prevention that are the pillars that allows patients to return to their roles in the community and resume productive work.

Across the country, Comprehensive Stroke Center (CSC) designation identifies hospitals that have achieved high standards for acute intervention of patients suffering from this disabling medical problem. Neurosurgeons are a key component and required element to achieve the highest level of Stroke Center accolade.

The F.A.S.T. campaign promulgated by the American Heart Association and National Stroke Association aims to heighten the awareness for stroke symptoms:

F:  Facial droopiness
A:  Arm weakness or numbness
S:  Speech problems
T:  Time (translates to faster recovery)

Time is the key factor that determines whether a patient can be helped in a meaningful manner or not. The sooner a patient seeks medical attention, the more options they will have for treatment, and the more likely they will be to have a good recovery. Along with recognizing these symptoms patients need to come to a center equipped to deal with the entire spectrum of stroke care and especially complex cases and comprehensive stroke centers with a robust involvement of neurosurgeons can guarantee the availability of the right kind of experts.

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