Dr. Yiping Li Spokane Neurosurgery

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Dr. Yiping Li Spokane Neurosurgery Inland Neurosurgery and Spine in Spokane Washington
Cerebrovascular and Skull Base Fellowship - Stan

Happy World Brain Day - today we celebrate and promote brain health. Today serves as a reminder of the brain's crucial r...
23/07/2025

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 recent cases of before and after imaging focused on minimally invasive treatment approaches such as coiling, thrombectomy, flow diversion, embolization, and stenting.

Case 1 is a young woman who presents 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.

Case 2 is a middle aged man with 5 prior strokes, he has exhausted medical treatment and comes in with another TIA/mini stroke. He was found to have severe blockage of the basilar artery. He underwent ballooning and stenting of the artery and discharged the following day. A year later the artery remains open and he has not had anymore strokes since the treatment.

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

Case 4 is a middle aged woman presenting with longstanding headaches but acute blurry vision and face numbness and then had a seizure in the ER. She was found to have a fistula that was causing engorgement of blood in the brain. She underwent a procedure to block the vessels off and this completely eliminated the fistula. She discharged home back to her normal on the second post operative day.

Young woman presents with 5 year history of intractable headaches and "mini stroke" symptoms. She was seen at the Univer...
27/06/2025

Young woman presents with 5 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.

She came to my clinic looking for any option to help with her symptoms.

Our initial approach was to slow down the blood flow through the AVM to see if this would help. We performed staged embolization of the AVM and with reducing the flow, her headaches resolved.

After a few staged embolization procedures, she asked if this was something that could be cured. Since the embolization procedures had gone well she asked that we remove the AVM to achieve a cure and prevent risk of future hemorrhage.

A year after her initial treatments with me, she underwent surgical resection of the AVM, achieving a complete resection.

Immediately after surgery she experienced right sided leg weakness but this lasted about a week. Ultimately she improved to the point where she was discharged home with mild incoordination of the leg but near full strength.

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

Middle aged man presents with swallowing difficulties and worsening balance. He got to the point where he was unable to ...
08/06/2025

Middle aged man presents 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, we used a camera 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.

40s year old man presents with progressive gait instability and numbness from the waist down. He had extensive work-up i...
20/05/2025

40s year old man presents with 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 we diagnosed him with a spinal arteriovenous fistula (AVF).

He underwent 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 the 3rd day after surgery his balance was better and numbness nearly resolved. At last follow up at 6 weeks he felt had fully recovered without residual symptoms.

Imaging shows spinal angiogram before and after surgery.

Middle age woman presents with sudden left arm and face weakness to the ER. She was found to have a brain bleed from a b...
05/03/2025

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

Middle aged man presented to the hospital with sudden onset headache and inability to walk. He was found to have an acut...
24/01/2025

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.

Large tumors along the skull base often need multi-staged operations for total removal; however, sometimes can perform a...
21/11/2024

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.

Not all ruptured aneurysms are the same. Some require detailed imaging and a very thoughtful plan with consideration of ...
14/11/2024

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.

Insular gliomas often present with seizures, headaches, or psycho emotional changes. Resection of more than 90% of the t...
18/09/2024

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.

Middle aged man has complete blockage of both vertebral arteries that feed blood to the back of the brain, including a s...
23/08/2024

Middle aged man has complete blockage of both vertebral arteries that feed blood to the back of the brain, including a severe narrowing / blockage of the basilar artery. His blood flows backwards from the right carotid artery into the basilar artery but has a hard time getting across the narrowing.

Due to these blockages, despite maximal medical treatment, he had multiple recurrent strokes, was dizzy and light headed when getting up, and had whooshing in his ears.

He underwent balloon angioplasty and stenting of the basilar artery from accessing the right carotid going backwards through the posterior communicating artery.

Post operatively his light headed was and dizziness resolved as did the whooshing in his ear. He was discharged home the morning after surgery.

Imaging shows the basilar artery narrowing before and after treatment

Young woman has been suffering from very loud ringing/whooshing in the right ear for many years. These symptoms got wors...
12/08/2024

Young woman has been suffering from very loud ringing/whooshing in the right ear for many years. These symptoms got worse over time and is now associated with headaches, visual complaints, and brain fog.

She was found to have venous sinus stenosis (narrowing of the major veins of the brain) on both sides, worse on the right compared to the left.

These veins drain blood out of the brain, and due to reduced blood flowing out of the brain, you could say her brain was “constipated” and built up pressure.

After further diagnostic tests, she was found to be a candidate for venous sinus stenting.

After the stent placement, she immediately had complete resolution of her right ear whooshing.

She was discharged home after a short overnight observation and at 6 week follow up she was cured from the ear ringing/whooshing, headaches, and visual complaints but also mentioned her coworkers felt she had more energy and seemed brighter.

Images show venous sinus stenosis/ narrowing before and after stent placement

A little delayed post but kudos to the new residency graduates at the U Wisconsin Department of Neurosurgery. Congratula...
12/07/2024

A little delayed post but kudos to the new residency graduates at the U Wisconsin Department of Neurosurgery.

Congratulations Mark and Dan! I’m proud of you both and know you will go on to do great things and help your communities.

Thank you to the U Wisconsin faculty for inviting me back as visiting professor to give a talk to the current and new residents. It was great to be back and remembering all the great times and even better people who have shaped me into what I am today.

Lastly 🎈🎉🎊 to those current residents who have persevered through another year of training, dedicating yourselves to your craft, your patients, and to helping your community.

Hope to see you all again soon.

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