2015 WORLD JOURNAL STROKE MONTH LECTURE SERIES PRESENTS: 中風和脑溢血的神经 外科治疗 5/16/2015 林寧神經外科主治醫師 Ning Lin, MD  

腦中風類型 腦溢血 (ICH) 腦中風 (卒中) 出血性中風 (Hemorrhagic Stroke) 缺血性中風 (Ischemic Stroke) 出血性中風 (Hemorrhagic Stroke) 腦溢血 (ICH) 蛛網膜下出血 (SAH)

出血性中風原因 高血壓 (Hypertension) 腦澱粉樣血管病 (Amyloid angiopathy) 顱內動脈瘤 (Cerebral aneurysm) 動靜脈血管畸形 (Arteriovenous malformation) 海綿狀血管畸形 (Cavernous malformation)

腦溢血 (Intracerebral Hemorrhage) 主要由於高血壓或腦澱粉樣血管病 需要排除血管畸形 恢復狀態取決於年齡和出血量

蛛網膜下出血 (Subarachnoid hemorrhage) 主要由於動脈瘤或血管畸形 再出血可能性高 需要緊急手術治療

顱內動脈瘤 (Cerebral aneurysm)

動靜脈血管畸形 (Arteriovenous malformation)

海綿狀血管畸形 (Cavernous malformation)

中風的神經外科治療 顯微手術治療(Microsurgical treatment) 血管內介入治療(Endovascular treatment)

動脈瘤顯微手術治療 Pre-operative Post-operative

動脈瘤血管內介入治療

動脈瘤血管內介入治療 Pre-operative Post-operative

動脈瘤血管內介入治療 Pre-operative Post-operative

頸動脈狹窄的治療 頸動脈內膜切除術(Carotid endarterectomy) 頸動脈支架(Carotid angioplasty and stenting) Pre-operative Post-operative

頸動脈支架 Pre-operative Post-operative

頸動脈支架 Pre-operative Post-operative

血管內介入治療急性缺血性中風 從症狀發作6-8小時 機械血栓切除 (mechanical thrombectomy) 動脈內注射tPA (Intra-Arterial tPA)

Turning Point The Era of Stent-Retrievers Technological advances Stent-retriever technology for safe, reliable performance Significant improvement in revascularization and patient outcomes vs older technology, proven in randomized clinical trials* ADD pictures showing generational advances? *Non FDA-Approved Therapies * Raul G Nogueira, et. al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet, 2012; 380: 1231-40 and Jefferey L Saver et. al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Int J Stroke; 2012, 1747-4949 Image courtesy of Stryker Neurovascular.

Recent Stroke Trials MR CLEAN ESCAPE EXTEND-IA SWIFT PRIME

血管內介入治療急性缺血性中風

血管內介入機械血栓切除

血管內介入機械血栓切除 Pre-operative Post-operative

對於腦中風危險因素 Modifiable (可修改) Increasing age (年齡的增加) Hereditary/Non-Modifiable (不可變化) Modifiable (可修改) Increasing age (年齡的增加) Family history of stroke (中風家族史) Prior TIA (短暫性腦缺血) Prior ischemic stroke (中風歷史) Prior heart attack (心臟病歷史) High blood pressure (高血壓) High cholesterol (高膽固醇) Smoking / tobacco use (抽煙) Diabetes (糖尿病) Physical inactivity / obesity (肥胖) Afib (心房纖維顫動) Carotid Artery Stenosis (頸動脈狹窄) End-stage renal disease (終末期腎臟病) American Heart Association. Heart Disease and Stroke Statistics 2012 Update At-a-Glance.

類似中風的其他病因 腦腫瘤 (Brain tumors) 癲癇(Seizures) 脊椎疾病 (Spinal disorders)

腦腫瘤 **

腦腫瘤

頸椎脊髓室管膜瘤

聯絡我們 林寧神經外科主治醫師 Ning Lin, MD 56-20 Main Street Flushing, NY 11355 718-670-1837 紐約長老會醫院 -皇后區 NYHQ Neurosurgery 56-45 Main Street Flushing, NY 11354 Ning Lin, MD 1305 York Avenue, 9th Floor New York, NY 10065 212-746-4684