Patient with Moyamoya disease treated with vascular bypass surgery.
Bangalore India, March 22, 2017: BGS Gleneagles Global Hospitals, a part of Parkway Pantai, successfully performed a surgery to treat a complex and rare neurological disorder. Pradeep, 26 years, developed sudden weakness of the right side of his body and difficulty in speaking. Symptoms gradually worsened over a few days and increased significantly three days prior to visiting the hospital. On examination, he was unable to speak fluently and had weakness of right upper and lower limb.
A MRI scan of the brain, indicated an ischemic stroke in the left half of the brain due to reduced blood supply. Following which an angiogram of the brain clarified that the two main blood vessels supplying the brain, known as internal carotid artery, were significantly narrowed and there was formation of multiple thin new blood vessels to continue blood supply to the brain. This is characteristic of a very rare disorder called Moyamoya.
Moyamoya disease is a disease in which certain arteries in the brain are constricted and the blood flow is blocked. Collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis. On angiography, these collateral vessels have the appearance of a “puff of smoke” (described as moyamoya) in Japanese. Moyamoya disease can be either congenital or acquired.
Drugs such as antiplatelet agents are usually given to prevent clots, but surgery is usually recommended. Since moyamoya tends to affect only the internal carotid artery and nearby sections, surgeons can direct other arteries, such as the external carotid artery or the superficial temporal artery to replace its circulation. The arteries are either sewn directly into the brain circulation or placed on the surface of the brain to re-establish new circulation after a few weeks
This patient was advised a vascular bypass surgery and EMS (encephalomyosynangiosis), in which the temporalis muscle is dissected and placed on the surface of the brain through an opening in the skull. Vascular bypass surgery is a technically demanding procedure which diverts the blood flow from a normal artery to the diseased artery to augment the blood supply to the brain.
Dr. H V Madhusudan, Chief Neurosurgeon and Head of Neurosciences, BGS Gleneagles Global Hospitals, commented on the case, “There are limited indications of a vascular bypass procedure such as Moyamoya disease, few vascular occlusive diseases, complex vascular aneurysm surgeries and some skull based tumors. In this patient, surgery helped in supplying the brain with adequate volume of blood and thereby improving his symptoms.”
Pradeep underwent the procedure that lasted over 4 hours in February 2017. Following which he was monitored for a day in the neuro ICU. He was shifted to the ward the next day and was discharged within the week. The surgery was technically challenging because both the donor and recipient vessels were thin and small. The surgery was done under high magnification using an operative microscope and micro-instruments. There can be multiple complications in the immediate and late postoperative period which require close observation. The patient has made almost complete recovery of the limb power and significant improvement in the speech. More importantly, he is protected from future strokes.
Mr. Thomas Mathew, COO, Gleneagles Global Hospitals, Bengaluru added, “Vascular bypass of the brain is a challenging surgery which requires extensive pre-operative care, cutting edge technology, experienced surgeons and a team of medical professionals to manage post-operative care and monitoring to avoid various complications that may arise from surgery. At BGS Gleneagles Global Hospitals, our team of doctors carry out similar complex neurovascular interventions frequently, around 5-6 surgeries a month.”