On November 8, 2023, Dr. Balgopal Karmacharya gave participants of the Online Lecture
Series an insight on the important role of neurosurgery in stroke management. Since stroke
is globally the second leading cause of morbidity and mortality, interdisciplinary treatment
is essential for a good outcome.
Traditionally, neurosurgeons primarily address patients with hemorrhagic strokes. However,
as Dr. Karmacharya highlighted, their involvement spans various stroke scenarios, including
acute ischemic strokes, post-thrombolysis hemorrhages, cerebral sinus thrombosis, and
subarachnoid hemorrhages.
Especially with the emergence of hybrid neurosurgeons, trained not only in traditional
approaches but also in microvascular procedures, thrombectomies have become an
important alternative treatment in patients with large vessel occlusions, severe ischemic
strokes, and cases of thrombolysis failure. Numerous studies emphasize the superior
outcomes of thrombectomies, especially for large vessel occlusions, compared to
thrombolysis or best medical care.
However, Dr. Karmacharya also gave examples of other neurosurgical interventions: In
patients suffering from malignant middle cerebral artery (MCA) infarction a decompressive
craniectomy, if applicable, can significantly improve outcomes and save lives. In fossa
posterior strokes or cerebellar infarction placement of an extraventricular drain is
performed to reduce volume and minimize brain stem compression. Neurosurgical
interventions also extend to cases like intracerebral hemorrhages, which account for 30-
40% of strokes in Nepal and surrounding areas. Surgical evacuation of the bleed, while not
conclusively improving functional outcomes, presents potential benefits with the
development of minimally invasive techniques. While the primary treatment in cerebral
venous sinus thrombosis involves anticoagulation, depending on clinical and radiological
features, neurosurgical interventions such as decompressive craniectomy in combination
with anti-edema measures can enhance survival and functional outcomes.
Dr. Karmacharya's insights highlighted the comprehensive role of neurosurgery in stroke
care. From advanced thrombectomies to tailored interventions in patients with
intracerebral hemorrhage, these developments offer an effective approach for improved
outcomes in stroke patients.
Thank you Dr. Balgopal and all participants for an interesting lecture and lively discussion!

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