Covid19 and risk of Stroke

The current Covid19 pandemic has dramatically changed the world and the way we live. The various ways in which Covid presents itself in people has not been clearly understood and new mechanisms are being learnt everyday.

One of the ways that Covid19 manifests itself is in the form of 'Stroke'. Acute Stroke in people suffering from Covid19 may present in many ways such as blockage of important arteries of the brain or bleeding within the brain. Blockage of important arteries supplying important arteries of the brain leads to acute loss of blood circulation to important parts of the brain and thus permanent damage to the brain resulting in disability or death. It has been observed that strokes in codiv19 occur predominantly in younger population than old. One of the mechanisms that is proposed to be the cause of stroke is a hyper coagulable state, which means increased tendency of the blood to clot. The exact mechanism of this hypercoagulable state is unknown, This has also led to administration of blood thinners to people affected with covid19 in the hope that the blood remains adequately thin so as to prevent abnormal clotting.

The main stay of treatment of such blockages leading to stroke is blood thinners and a procedure called 'mechanical thrombectomy', which involved extracting the clot from the area of blockage by angiography techniques. The results of treatment are good, although not as good as in non-covid patients.

Due to the widespread of the novel coronavirus, the incidence of new strokes in especially younger population is likely to increase significantly and hence it is imperative to be aware of signs and symptoms of stroke. For more details on how to identify stroke, click on https://www.youtube.com/watch?v=6oGUwNxRbmU&feature=youtu.be

Supraorbital approach to anterior cranial base meningioma

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Awake Craniotomy for Brain Tumor Resection

Awake brain surgery, also called awake craniotomy, is a type of procedure performed on the brain while the person is awake and alert. Most of the brain surgeries involve general anesthesia wherein the patient is completely sedated and paralyzed and his/her breathing is controlled by the ventilator.

Awake brain surgery involves keeping the person awake and alert during surgery so as to be able to monitor his/her brain function while a surgical procedure is being performed on the brain.

Awake brain surgery is used to treat some brain tumors that are in close proximity to important functional areas of the brain such as the speech area and motor area. Patient’s responses help the surgeon to ensure that the functional area under consideration is preserved, thus preserving function. The procedure also lowers the risk of damage to functional areas of your brain that could affect your vision, movement or speech.

Why it's done?

If a tumor or section of your brain that causes seizures needs surgical removal, doctors must be sure that they are not damaging an area of the brain that affects your language, speech and motor skills.

It's difficult to pinpoint those areas exactly before surgery. Awake brain surgery allows the surgeon to know exactly which areas of the brain control those functions and avoid them.

Before surgery

Not all patients are fit candidates for awake craniotomy. The treating neurosurgeon and neuroanesthesiologist examine the patient thoroughly and discuss the steps in surgery. The patient is an active participant in this surgery and his/her responses during surgery will play a pivotal role in preserving brain function. A neuropsychological assessment is performed to assess deficits in higher mental functions and speech prior to the surgery.

Before surgery, the neurosurgeon or a speech-language pathologist may ask the patient to identify pictures and words on cards or on a computer so that the answers can be compared during surgery.

During surgery

Brain mapping

An anesthesia specialist (anesthesiologist) will apply numbing medications to the scalp to ensure your comfort.

During the procedure, doctors place the patient’s head in a fixed position to keep the head still and ensure surgical accuracy. Some of the hair will be clipped. Your surgeon then removes part of the skull to reach the brain.

The patient may be sedated and sleepy while part of the skull is removed in the beginning of the surgery, and also when doctors reattach the skull at the end of the surgery. During the surgery, the anesthesiologist will stop administering the sedative medications and allow the patient to wake up.

If the brain tumor or epileptic focus is close to areas of your brain that control vision, speech or movement, the neurosurgeon will conduct brain mapping. This provides the neurosurgeon with a map of the brain centers that control each of these functions. The surgeon also can perform brain mapping deeper in your brain during surgery.

The anesthesiologist and surgical team carefully monitors and assess your body and brain functions and alerts your surgeon if surgery affects brain function.

After surgery

The patient is observed in the intensive care unit for a while after surgery and spends about three to five days in the hospital.

The patient generally may return to work and normal activities in six weeks to three months.

Stroke Rehabilitation

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Resection of Lumbar Schwannoma

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Retrosigmoid approach to resection of Lower cranial nerve Schwannoma

Superficial Temporal Artery Dissection for STA-MCA bypass procedure

The video demonstrates the technique of superficial temporal artery dissection for STA-MCA bypass procedure

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