Dr. Yiping Li Spokane Neurosurgery, 105 W 8th Avenue #200, Spokane, WA (2025)

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.

05/20/2025

Middle aged man has progressive gait instability and numbness from the waist down. He had extensive work-up including MRI of the spine which initially was unrevealing but due to his progressive symptoms, further imaging consisting of a spinal angiogram was performed where he was diagnosed with a spinal arteriovenous fistula (AVF).

The patient had surgery for disconnection of the fistula via a laminectomy. Immediately following surgery he felt his numbness was improving and by the time he discharged home on a few days after surgery his balance was better and numbness nearly resolved. At last follow up at many months later he felt had fully recovered without residual symptoms.

Imaging shows spinal angiogram before and after surgery.

03/05/2025

Middle age woman presents with sudden left arm and face weakness to the ER. She was found to have a brain bleed from a blood vessel mass called an AVM.

She underwent surgery for removal of the AVM and the surrounding blood clot. She did well after the surgery, required some physical therapy but ultimately discharged home.

At last follow up she was back to her normal strength and her AVM was cured after complete surgical removal.

Imaging shows the AVM before and after surgical removal

01/24/2025

Middle aged man presented to the hospital with sudden onset headache and inability to walk. He was found to have an acute bleed in the cerebellum. Further investigation revealed that he had ruptured from a brain AVM.

He was initially discharged to rehab, then came back for surgical resection of the AVM. He did well from the operation and discharged home on the third post operative day.

Imaging shows the acute bleed and the AVM before and after surgery.

11/21/2024

Large tumors along the skull base often need multi-staged operations for total removal; however, sometimes can perform a skull base approach for resection via a single operation.

Young patient with a right sided trigeminal nerve schwannoma and facial numbness presents for surgical resection. The surgery was done via an extra-dural (did not expose the brain) trans-cavernous approach with extension of the surgical resection down from the middle cranial fossa to the posterior cranial fossa for resection of this tumor that was compressing the brainstem.

She tolerated the procedure well and discharged home after 2 nights in the hospital.

MRI imaging showing before and after pictures.

11/14/2024

Not all ruptured aneurysms are the same. Some require detailed imaging and a very thoughtful plan with consideration of coiling vs clipping while others force you to immediately jump in the line of fire.

Middle aged man presents to the ER after suffering a sudden severe headache and subsequent collapse witnessed by family. When he arrived he was in a coma, paralyzed on the right side and his left pupil was fixed and dilated suggesting his brainstem was being damaged by the increased pressure. He was quickly stabilized and a CT scan showed a large hemorrhage with significant brain compression.

Even though there was no contrast given, you can see the large / giant aneurysm rupture as the cause.

Often times patients in this condition do not make a good recovery and may remain in a persistent vegetative or debilitated state despite all aggressive treatment, but his family wished to give him a chance given his young age.

Unfortunately due to his near fatal condition, we could not delay him any longer with additional imaging and rushed him emergently to the OR for hematoma evacuation and clipping of the aneurysm.
At 6 week follow up he made a remarkable recovery. Despite having some speech delay and right arm weakness, he was cracking jokes and walked into clinic under his own power.

09/18/2024

Insular gliomas often present with seizures, headaches, or psycho emotional changes. Resection of more than 90% of the tumor is associated with increased survival and decreased malignant / cancerous transformation.

These tumors can be surgically removed through two main approaches which are chosen based on anatomical factors:

The trans cortical route often requires resection of normal frontal or temporal lobe and is often used for posterior extending tumors.

The trans sylvian route does not involve resection of normal brain but does require meticulous dissection and preservation of the blood vessels covering the tumor.

My personal preference is the trans-sylvian route to avoid removing normal brain matter required to create a window to the tumor as done in the trans cortical approach. The trans sylvian approach can avoid unnecessary injury to the underlying tracts of the brain especially with gentle retraction techniques and can often be performed asleep without the need for awake surgery to map the function of the brain, increasing the comfort of the patient.

Dr. Yiping Li Spokane Neurosurgery

10/23/2025

09/24/2025

08/13/2025

07/23/2025

06/27/2025

06/08/2025

05/20/2025

03/05/2025

01/24/2025

11/21/2024

11/14/2024

09/18/2024

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