Neuro-surgery

Manipal Conducts Surgery to Treat Moyamoya

In Moyamoya, two major arteries which supply blood to the majority of the brain get progressively narrowed and blocked

Manipal Hospital, Bangalore has recently conducted brain bypass surgery called Superficial Temporal artery-Middle Cerebral artery bypass (STMC bypass) to treat a patient suffering from Moyamoya disease. The surgery was conducted by Dr Swaroop Gopal, Consultant Neurosurgeon at Manipal Hospital.

The patient was a 10-year-old girl, from Burdhwan, Kolkata, (West Bengal). She was apparently normal four months ago, when her parents noticed weakness of her left arm while doing routine activities at home and at play. She was taken to local doctor at Burdhwan, who clinically evaluated her and clinically could detect weakness of the left arm.

"This was an unusual finding at this age, and a CT scan of the brain was performed, which revealed that the child had a stroke involving the right side of the brain," said Dr Gopal. Since the child was only 10-year-old and also since a stroke was uncommon at this age, the parents wasted no time waiting and rushed her to Manipal Hospital, Bangalore.

A week later, when she was brought to Manipal hospital, she was evaluated in the outpatient services by a paediatric neurologist Dr Taranath Shetty. The patient was further evaluated with an MRI scan of the brain scan as well as a MR angiogram (MRI scan which shows the arteries of the brain like an angiogram) was done which showed that she was suffering from Moyamoya syndrome.

Moyamoya is a Japanese word for 'puff of smoke' and is a disease of uncertain cause. In this illness, the two major arteries which supply the majority of the brain get progressively narrowed and blocked. This leads to reduced blood supply to the brain since the smaller two vertebral arteries in the back portion of the brain are unable to cope up with supplying the whole brain.

This precarious situation can lead to a sudden massive brain stroke or chronic brain damage or hemorrhage which would lead to further weakness of the limbs, delayed growth or mental deterioration.

"There is no medical treatment for this condition apart from blood thinners like aspirin. To prevent a stroke, the only treatment option for Moyamoya disease is STMC bypass," Dr Gopal.

During this surgery tiny arteries supplying the scalp called temporal arteries are connected through a window made in the skull, to even smaller arteries of less than one millimeter on the surface of the brain thus bypassing the block. The arteries are sutured with very fine sutures and needle which is barely visible to the naked eye. Apart from being a child of only 10 years to undergo major surgery lasting eight hours, the other difficulties that Dr Gopal encountered were that the arteries were of very small diameter (less than 1mm), and extremely friable and tear easily.

"Brain bypass surgery is an extremely technically demanding procedure, which is useful in treating a variety of brain disorders like aneurysms, strokes and Moyamoya as illustrated by this patient," explained Dr Gopal, who has been doing this procedure since 2008 and has successfully managed several patients so far. Asked about the incidence of Moyamoya in India, Dr Gopal said, "It is a rare disease. Case reports usually. Over last 15 years, I have seen about three to four patients. Pinky is the youngest." He refused to divulge the cost of the surgery.

"Pinky has been discharged from the hospital," informed Dr Gopal.

EH News Bureau