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.

10/31/2025

Young woman comes into the ER with another episode (3 total events now over the past 6 months) of face drooping, arm weakness, and arm numbness. She was found to have a small stroke. Prior imaging of her neck arteries did not show any blockage but this time the doctors imaged her brain vessels and found that she has blockages of the major arteries of the brain on both sides. She was transferred to our hospital for further evaluation.

After additional work-up, she was found to have moyamoya disease - a condition where there is gradual narrowing and blockage of the large brain vessels that result in strokes and brain bleeding.

The treatment for this just like in the heart in cases of blockage, is to under go a bypass which consists of re routing the blood flow to the brain by connecting a different artery to improve the blood flow.

The patient was observed in the hospital for 3 days after surgery and discharged home. She presented back a couple of months later and had the same surgery performed on the other side.

Over the past 5 years she has not had any recurrent stroke events.

Images show the artery occlusions and surgery.

10/23/2025

Sometimes large aneurysms can cause compression of cranial nerves. In this case a young person presents with progressive vision loss. She was found to have a large aneurysm compressing the nerve to her eye.

Although flow diversion (stenting) has revolutionized the treatment of these aneurysms, sometimes to get the pressure off the nerves quickly, surgery is still superior.

Here are some images of the aneurysm before and after surgery where blood to the aneurysm was stopped, the aneurysm was deflated, and a simple clipping was performed to relieve pressure onto the nerve of the eye.

09/24/2025

Young man presents to the ER with first time seizures and was found on further work-up to have a large brain mass. He was monitored closely in the hospital as the tumor was causing severe brain swelling. Ultimately after removing the tumor he was discharged home 1 week later and on last follow-up has returned to full time work. The tumor was an atypical meningioma.

Giant skull base tumors such as clinoidal meningiomas are often very challenging cases. These tumors can encircle the carotid artery and branches which sometimes make their removal extremely risky or impossible. However, depending on the tumor consistency and with being patient, total removal and cure can sometimes be achieved (after a 14 hour operation).

08/13/2025

Meningiomas are typically benign tumors that come from the lining of the brain. However, just like in real-estate, they're all about location location location.

Here is a case of a large meningioma causing brain compression, personality changes, and short term memory in a young patient who over a few months started recently struggling mightily in school. Ultimately due to this drastic change, further evaluation was done revealing this mass.

Imaging before and after surgery to remove the tumor. The patient improved after surgery and was discharged home without new issues.

07/23/2025

Happy World Brain Day - today we celebrate and promote brain health. Today serves as a reminder of the brain's crucial role in overall health and well-being. Taking good care of the brain includes quick recognition of potential signs of urgent brain diseases such as sudden onset worst headache of life, sudden weakness, numbness, slurring of words, vision, and/or balance issues.

Our awesome team including doctors, nurses, techs, MAs, PCCs, office staff, and everyone in between here at SHMC surgically treat over 500 aneurysms, strokes, AVMs, brain fistulas, and other brain blood vessel diseases every year.

Below are some examples of brain diseases.

Example 1 is a person with sudden onset severe headache found to have multiple brain aneurysms. This patient underwent flow diversion and coiling of the aneurysms and discharged the next day. At last follow up no aneurysms remain.

Example 2 is a person with many prior strokes and has exhausted medical treatment continues to have many TIA/mini strokes. They were found to have severe blockage of the basilar artery and underwent ballooning and stenting of the artery and discharged the following day. More than years later the artery remains open and has not had anymore strokes since the treatment.

Example 3 is a person who presents acute inability to talk or move the right body. They were found to have a blockage in the neck as well as in the brain. They required clot removal in the neck followed by stenting, and then clot removal in the brain. They made a great recovery and was discharged home few days later without any significant deficits.

Example 4 is a person presenting with longstanding headaches but acute blurry vision and face numbness and then had a seizure in the ER. They were found to have a fistula that was causing engorgement of blood in the brain. They underwent a procedure to block the vessels off and this completely eliminated the fistula. They discharged home with resolution of symptoms.

06/27/2025

Young woman presents with many year history of intractable headaches and "mini stroke" symptoms. She was seen at the University Hospital in California where she was told she had an untreatable large brain AVM because it was located deep and in the movement center of the brain which would result in complete right sided paralysis. The AVM was causing local brain damage from "vascular steal" where the AVM steals blood away from the brain.

Her treatment approach was to slow down the blood flow through the AVM to see if this would help. She had staged embolization of the AVM and with reducing the flow, her headaches resolved.

After a few staged embolization procedures, she wanted to be aggressive and consider treatment for cured. Since the embolization procedures had gone well she wanted to have the AVM removed to achieve a cure and prevent risk of future hemorrhage.

The patient underwent surgical resection of the AVM, achieving a complete resection.

Patient initially experienced some right sided leg weakness but this quickly improved and was discharged home after a few days.

Imaging shows the AVM with local brain damage, after embolization, and ultimately after surgical resection without residual.

06/08/2025

Middle aged man has with swallowing difficulties and worsening balance. He got to the point where he was unable to swallow without choking and required a feeding tube. His balance also worsened to the point of needing a cane/walker.

Ultimately he was found to have a tumor in the brain severely compressing the brainstem. The tumor was also encircling the basilar artery which is a very critical vessel.

The patient underwent urgent surgical resection of the tumor via an approach through the nostrils. Just as the ancient Egyptians scooped out the brain for mumification, a camera was used to visualize the base of the skull and drilled through the back of the nose sinuses to remove the tumor.

Post operatively his swallowing function began to improve as did his balance. He was discharged for rehab and at last follow up he was back to walking and eating by himself.

MRI shows the tumor before and after surgery with last MRI without evidence of any remaining tumor.