Neurosurgery for Ischemic and Hemorrhagic Stroke

  • Thomas J. Sorenson
  • Enrico Giordan
  • Giuseppe LanzinoEmail author


The term stroke refers to damage of the brain parenchyma which can be secondary to occlusion of a blood vessel causing ischemia (ischemic stroke) or to extravasation of blood outside the confines of the vascular system (hemorrhagic stroke). Patients presenting with acute ischemic stroke may require a variety of medical or interventional management strategies, including mechanical clot retrieval, carotid endarterectomy, carotid stenting, bypass, or decompressive craniotomy. Patients presenting with hemorrhagic stroke secondary to a ruptured vascular lesion may require more extensive management of both the hemorrhage and the lesion. In this chapter, we summarize the most common clinical presentations of patients with ischemic and hemorrhagic strokes and briefly describe modern therapeutic modalities for the most common pathologies.


Ischemic Hemorrhagic Stroke Management Surgery Endovascular 

Suggested Readings and References

  1. 1.
    Saver JL, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316(12):1279–88.CrossRefGoogle Scholar
  2. 2.
    Brott TG, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021–31.CrossRefGoogle Scholar
  3. 3.
    Rodriguez-Hernandez A, et al. Bypass for the prevention of ischemic stroke. World Neurosurg. 2011;76(6 Suppl):S72–9.CrossRefGoogle Scholar
  4. 4.
    Schaller B. Extracranial-intracranial bypass to reduce the risk of ischemic stroke in intracranial aneurysms of the anterior cerebral circulation: a systematic review. J Stroke Cerebrovasc Dis. 2008;17(5):287–98.CrossRefGoogle Scholar
  5. 5.
    Gregson BA, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke. 2012;43(6):1496–504.CrossRefGoogle Scholar
  6. 6.
    Dobkin BH. Motor rehabilitation after stroke, traumatic brain, and spinal cord injury: common denominators within recent clinical trials. Curr Opin Neurol. 2009;22(6):563–9.CrossRefGoogle Scholar
  7. 7.
    Mendelow AD, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387–97.CrossRefGoogle Scholar
  8. 8.
    Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65(4):476–83.CrossRefGoogle Scholar
  9. 9.
    Schaller C, Pavlidis C, Schramm J. [Differential therapy of cerebral arteriovenous malformations. An analysis with reference to personal microsurgery experiences]. Nervenarzt. 1996;67(10):860–9.Google Scholar
  10. 10.
    Stapf C, et al. Predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology. 2006;66(9):1350–5.CrossRefGoogle Scholar
  11. 11.
    Sandalcioglu IE, et al. Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results. J Neurol Neurosurg Psychiatry. 2002;72(3):351–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Thomas J. Sorenson
    • 1
    • 2
  • Enrico Giordan
    • 1
  • Giuseppe Lanzino
    • 1
    • 3
    Email author
  1. 1.Department of Neurologic SurgeryMayo ClinicRochesterUSA
  2. 2.School of MedicineUniversity of MinnesotaMinneapolisUSA
  3. 3.Department of RadiologyMayo ClinicRochesterUSA

Personalised recommendations