””As a public welfare website, it provides a very good platform for doctor-patient communication. I take this platform to answer several questions of common concern to patients with cerebrovascular disease. I often encounter patients complaining to me about the difficulty of registering in the outpatient clinic. If you can’t get an appointment, you can come directly to the neurointerventional ward on the 3rd floor of the radiology building of Beijing Tiantan Hospital on Monday morning from 8:00 to 8:30 am to see me for an additional appointment. If the patient’s condition is urgent, the patient’s family can bring all imaging materials to the ward on any weekday (Monday through Friday) from 8:00 a.m. to 8:30 a.m. However, because I also have other duties such as research, teaching, and clinic visits, I cannot guarantee that all non-booked patients can find me in the ward. Please be assured that I will not turn away anyone who is a genuine patient and not a “scalper”. Lastly, I do not require patients to be seen in person, but I do require that family members be fully informed of the patient’s condition and bring all imaging data. There are other ways to register, please refer to the articles “About Dr. Lu Ming’s Clinic” and “About the Joint Special Needs Clinic of Dr. Wang Rong, Dr. Ma Ning and Dr. Lu Ming”. Since Beijing Tiantan Hospital has one of the best neurosurgery departments in Asia and is open to patients from all over the country, it is an objective fact that hospitalization is difficult. Please refer to the article “About the hospitalization process of neurointerventional department in Beijing Tiantan Hospital” for the specific hospitalization process. If the patient’s condition is urgent, it is recommended to go to the neurosurgery department of Armed Police General Hospital and the neurosurgery department of Coal General Hospital for hospitalization. About “cure rate”, “surgery success rate” and “surgery risk” “cure rate”, “surgery success rate” and “surgery risk The “cure rate”, “surgery success rate” and “surgery risk” are the issues that all patients are concerned about. In fact, the “cure rate” or “surgical success rate” of a disease are statistics from the patient population, and there is no question of “rate” for an individual patient. For a given individual patient, he/she is either part of the “success rate” or part of the “failure rate”, whether “success” or “failure” for him/her. The “success” or “failure” for him/her is 100% (that is a bit cruel). Therefore, for a particular patient, the doctor’s perspective may focus on 1) whether the patient’s indication for surgery is clear; 2) the trade-off between the risks and benefits of surgery; and 3) how to individualize the treatment according to the patient’s specific condition. At this point, many patients will complain, “I asked a question about “success rate” and the doctor gave me such an answer, is this not a perfunctory answer? What is the difference between such an answer and no answer? Doctors are so cunning and sly! Then I can only sincerely inform all patients that this is science, especially clinical medicine as a practical science, the results of which are not subject to the will of doctors and patients. Although the statistics do not apply to individual patients, I will briefly summarize the current status of treatment of several cerebrovascular diseases within my scope of practice for the reference of patients: 1. Ruptured cerebral aneurysms (subarachnoid hemorrhage) should be treated surgically as soon as possible, and conservative treatment cannot prevent rebleeding of the aneurysm. In patients with ruptured cerebral aneurysms treated conservatively, the re-rupture rate is as high as 20% within 2 weeks, and the residual death rate is as high as 60%-80% within 1 year. Asymptomatic aneurysms may be detected during physical examination. It is still controversial whether asymptomatic aneurysms should be treated with active surgery, see the following article “Timing of Intracranial Aneurysm Intervention”. There are two types of surgical treatment for cerebral aneurysms, one is endovascular interventional embolization and the other is open cranial clamping. With the progress of interventional techniques and materials in the past two decades, endovascular interventional treatment has gradually replaced cranial clamping as a more minimally invasive surgical procedure and has become the preferred treatment for cerebral aneurysm patients. In developed countries in Europe and the United States, more than 80% of patients prefer interventional treatment; in our hospital, the ratio of interventional treatment to cranial clamping was about 5:3 in 2012; however, in primary hospitals, due to factors such as the fact that interventional technology is not yet widespread and patients’ economic conditions, more than half of patients may rely on cranial clamping treatment. In terms of the average operation cost, interventional treatment may be 2-3 times or more than open treatment, so in the current situation of China, the high cost of interventional treatment becomes a bottleneck limiting the popularity of interventional technology. 4. The incidence of complications related to cerebral aneurysm interventions is about 5%-10% or less. There are mainly two kinds of disabling and fatal complications, one is intraoperative aneurysm rupture, with an incidence of 3%-5%; the other is intraoperative acute thrombosis, with an incidence of 3% or less. The recurrence rate after cerebral aneurysm intervention is mainly related to the size of the aneurysm. The recurrence rate of aneurysm within 1 cm in diameter is less than 5%-10%; however, the recurrence rate of aneurysm over 1 cm in diameter may be as high as 10%-30%. Recurrence is usually concentrated within 2-3 years after surgery, and it is relatively safe if it does not recur for more than 2-3 years. However, cases of recurrence 8-9 years after surgery have been reported in the literature. Recurrent cerebral aneurysms can still be treated by re-intervention. The cure rate of interventional surgery for cerebral arteriovenous malformation is closely related to the size and location of the lesion. But the diameter of more than 3cm, especially in the functional brain area of the brain arteriovenous malformation, generally can not be cured through simple interventional surgery, postoperative residual malformation group may need to continue to perform Gamma knife treatment. 7, brain arteriovenous malformation intervention-related complication rate is currently controlled within 5%. However, for recurrent bleeding and cerebral arteriovenous malformation located in the functional brain area, patients may need to pay the price of neurological deficits in exchange for life. The cure rate of dural arteriovenous fistula is closely related to its scope. A lesion with limited scope and few blood supplying arteries can be cured by one or more interventions; however, a lesion with extensive scope and complex blood supplying arteries is difficult to cure, and the purpose of intervention is to partially embolize the fistula to relieve clinical symptoms. The interventional treatment of dural arteriovenous fistula in the cavernous sinus area (carotid cavernous sinus fistula) is more effective and can be cured through various accesses such as arterial access and venous access, with an overall cure rate of more than 80%-90%. Because of the cranial nerves that govern eye movement and facial sensation (the motoneurotic nerve, the talocrural nerve, the trigeminal nerve, and the abducens nerve), a small number of patients may experience postoperative eye movement disorders and facial numbness, and some patients may develop peripheral facial paralysis after surgery, but more than 80% of them will recover within six months after surgery. Finally, we emphasize again that the above statistics are only generalized, and individual analysis of the condition, surgical indications, surgical plan and expected surgical results is needed for a specific patient. Prognosis Prognosis, as defined by Baidu, is “the prediction of the likely course and outcome of a disease. It includes both the determination of specific consequences of the disease (such as recovery, the appearance or disappearance of certain symptoms, signs and other abnormalities such as complications, and death) and the provision of temporal clues, such as predicting the likelihood of a certain outcome within a certain period of time. Because prognosis is a possibility, it refers primarily to groups of patients rather than individuals.” In short, prognosis is a clinical outcome that, like the concepts of “cure rate” and “surgical success”, is still specific to the patient population rather than the individual. Therefore, it is difficult for a competent physician to predict the clinical outcome of a particular patient. There is no shortage of examples of patients with advanced cancer who are deemed by their doctors to have only six months to live, but are still alive and well years or even decades later. In the clinical setting, I encounter many family members of patients with severe cerebrovascular disease who ask “when will the patient wake up” or “how hopeful is the patient? There are also some anxious family members who ask me through the Internet “when will the patient wake up”, “will the patient survive”, “will the patient recover from paralysis”, “when will the headache be relieved”. In fact, such questions are difficult to answer even for the doctors in charge who are always checking the room every day. In fact, such questions are difficult to be answered even by the doctors in charge who visit the ward every day. Some patients’ families also seek help online for treatment plans during the most dangerous acute stage when the patient’s condition may change at any time, and I often provide treatment principles while strongly suggesting the patient’s family to communicate with the local doctor in charge, because the doctor in charge knows the condition best and will give explanations and individualized symptomatic treatment. The online reply from a specialist thousands of miles away is no substitute for face-to-face consultation and treatment by a licensed physician, and cannot even catch up with the changes in the patient’s condition. Some patients are willing to transfer to our hospital for various reasons. For patients in the stable stage, I will inform them of the process of making an appointment for hospitalization. However, for patients in the acute stage of cerebral hemorrhage, I do not recommend long-distance transfer because of the risk of travel and the need to wait in line for hospitalization in our department, so local treatment or transfer to the nearest hospital with consultation and treatment conditions is the best policy. Some family members of patients with subarachnoid hemorrhage caused by ruptured cerebral aneurysm also ask, “The local hospital does not have surgical conditions, so if we transfer them, will there be any risk on the way? It is recommended to transfer to the nearest hospital with medical conditions as soon as possible”. Some patients’ families have asked me to consult them online, but I can only reply with “Sorry, I do not accept private invitations from patients”, because private consultations by specialists are not in accordance with the regulations. If the patient has the intention to invite a specialist from a higher level hospital, he/she needs to apply to the medical office of the local hospital through the doctor in charge, and then the medical office of the local hospital will send a fax of “invitation to consultation” to the medical office of the higher level hospital. Personally, I suggest that if the local hospital has the ability to treat, or rely on the local hospital experts, because after all, the external consultation will delay the work, and the proposed experts may not be available.