The Case History of Jennifer
Surgical Treatment for Moyamoya Disease: Building bridges to provide collateral pathways for the brain circulation in the prevention of stroke
Moyamoya disease is a cerebrovascular condition that predisposes affected patients to suffer strokes and intracerebral hemorrhage in association with progressive narrowing of the intracranial portion of the carotid arteries. This disease affects predominantly younger adults and pediatric patients who may experience symptoms of TIA (transient ischemic attacks). TIAs are characterized by sudden and transitory (less than few hours) neurological symptoms such as weakness of the upper or lower extremities, visual loss, sensory abnormalities (tingling, numbness, etc), loss of balance, or speech difficulties both understanding or producing language. In occasions, patients affected with this condition may present with strokes, that is, neurological deficits that do not resolve in few hours. There is no medical treatment for this condition, and its early recognition is important to establish the need of the possible alternatives of treatment. The main goal of the treatment is to provide alternative ways for the blood to reach the brain, as the carotid arteries get progressively narrow in the course of the disease. This is achieve by constructing either direct connections between the arteries of the scalp and the arteries of the brain (bypass) or by indirectly allowing the natural formation of connections between these two groups of vessels by putting them in close proximity and removing the barriers that impede their development (portions of the skull and the hard coverings of small portions of the brain). These later procedure is known as encephaloduroarteriosynangiosis (EDAS) or indirect bypass. Either form of treatment requires expertise in microvascular and microsurgical techniques to preserve these delicate vessels and guarantee appropriate connections between these vessels. These procedures are very effective in providing the alternative pathways for the blood to reach the regions of the brain that require additional circulation preventing the development of further TIAs or strokes.