BGS Gleneagles Global Hospitals performs vascular bypass surgery for rare neuro disorder

The patient Pradeep, 26 years, developed sudden weakness of the right side of his body and difficulty in speaking. Symptoms increased significantly three days prior to visiting the hospital.

A brain MRI scan indicated an ischemic stroke 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 with a formation of multiple thin new blood vessels which is characteristic of a very rare disorder called Moyamoya.

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, said “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.”

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, he added.

Thomas Mathew, COO, Gleneagles Global Hospitals, Bengaluru said that vascular bypass of the brain is a challenging surgery which requires extensive pre-operative care, experienced surgeons to manage post-operative care and monitoring to avoid various complications that may arise from surgery. The team performs similar complex neurovascular interventions of around 5-6 surgeries a month.

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