Dr. Yiping Li Spokane Neurosurgery

03/29/2026

Middle age woman with high blood pressure was found down by family unable to speak and unable to move the right side of her body. She was brought into the ER where a CT showed a large bleed in the left basal ganglia.

She was taken urgently to the operating room where through a 1 cm burr hole, the hematoma was evacuated. Day after surgery she started to say one or two word sentences and was able to move her leg. At 3 month follow up she regained the ability to walk and was speaking more fluently.

For those of you who work in this space, you'll recall that prior to 2015 there were countless studies showing how removing blood clots from patient's arteries during an acute ischemic stroke was "futile". Many neurologists and neurosurgeons around the world thought stroke was untreatable and only preventable. Luckily, not everyone gave up because some of us saw the benefits first hand. Fast-forward to today, once we determined the optimal patient and timing of intervention, aspiration of clot for treatment of acute ischemic stroke has become the standard of care.

Similarly for large bleeds in the brain, historical and contemporary data show that these patients do not benefit from surgery. However, minimally invasive treatments have shown promise and I truly believe there is benefit to this operation. The question remains who is the optimal patient and what is the optimal timing of intervention.

Hopefully those of us who see the benefit of this operation won't give up on our patients. Neurosurgery is about accepting challenges and pushing boundaries.

03/14/2026

Young man presents with sudden paralysis of the left arm and leg, facial droop, double vision with difficulty moving his eyes, and difficulty speaking. He was evaluated in the ER and found to have acute bleeding within the brainstem in the pons.

Initially he was diagnosed with a hemorrhagic stroke and thought to be due to high blood pressure; however, follow up imaging a week later showed continued enlargement of the bleed.

Due to the patient's age, I suspected that there was an underlying blood vessel mass called a cavernous malformation, which is like a hemorrhoid of the brain / tangle of fine blood vessels that can become engorged and cause local bleeding and damage.

The patient underwent urgent surgical resection of the mass due to progressive bleeding. The patient tolerated the procedure well. Post operatively he started to regain the movement in his arm and leg and by 6 weeks follow up he was walking without assistance and was able to hold a fork and eat with his left arm. He still had some double vision but this was also improving. Imaging shows a brainstem pontine cavernoma before and after surgical resection.

03/04/2026

02/28/2026

Middle aged woman presents with progressive headaches along the top of her head. She has had on and off headaches for a few years but over the past few months they have become more frequent and severe. Further evaluation reveals a brain aneurysm located near the top and front her of head.

Due to her risk factors as well as the aneurysm characteristics, she wished to have preventative treatment of the aneurysm.

The aneurysm has a relatively wide neck and would have historically been best treated with surgical clipping or stent assisted coiling; however, the patient wanted a minimally invasive option but was hoping not to need blood thinners and therefore wanted to avoid a stent.

To work around these considerations, a newer device called the WEB (woven endo bridge) device was thought to be the best option. The WEB is a acts like a pre-shaped plug and works by blocking blood flow along the aneurysm neck and can be placed without the need for heavy duty blood thinning medications.

The patient underwent the procedure which was performed via a puncture in the wrist and a WEB device was delivered to occlude the aneurysm. The patient tolerated the procedure well and was discharged home the following day.

02/21/2026

Young woman presents with couple month history of a loud annoying whooshing sound in her right ear. She developed this after heavy lifting and straining. It took almost a year but she was ultimately diagnosed with a spinal fistula.

Although most spinal fistulas present with progressive, slowly developing insidious neurological deficits (usually leg weakness, poor balance, and numbness or tingling). This occurs usually due to congested veins. The spinal cord in lack of a better term "becomes constipated" and malfunctions or has sudden bleeding inside the spinal cord or canal.

Rarely spinal fistulas especially higher up in the neck, can present with pulsatile tinnitus or a constant whooshing in the ear and are often missed on initial evaluation as most people focus on the ear or the brain.

The patient underwent an awake occlusion of the vertebral artery venous fistula which fed directly into the venous plexus at multiple segments within the vertebral artery. Imaging shows before and after treatment.

She tolerated the procedure well and was discharged home the next day. At 3 months follow up she had no neurological symptoms and her whooshing went away.