Doha, 6 October, 2019: Late last month the neurosurgery team from Hamad Medical Corporation’s (HMC) Hamad General Hospital performed a brain bypass surgery on a 30-year-old patient from the Philippines, marking the tenth procedure performed since the introduction of the Brain Re-Vascularization Program two years ago. HMC is currently the only healthcare provider in the region to offer the surgery, which is a last-resort treatment for patients suffering from symptoms of decreased blood flow due to Moyamoya disease.
“Moyamoya is a progressive disease that does not improve without treatment. It develops over months or years and is caused by blocked arteries at the base of the brain. The rare condition, which is more common in the childhood age group, affects only about one in a million people,” said Dr. Sirajeddin Belkhair, Senior Consultant, Neurosurgery and Head of the Neurosurgery Department at Hamad General Hospital.
“The name ‘Moyamoya’ means ‘puff of smoke’ in Japanese and describes the appearance of tiny vessels that form to compensate for the blockage. As the normal blood vessels narrow and become blocked, the condition predisposes affected patients to stroke,” explained Dr. Belkhair.
“While Moyamoya itself is not curable, surgery to provide alternative blood flow to the brain prevents related symptoms and can significantly reduce stroke risk. As the arteries become narrower, the brain forms tiny blood vessels to create new pathways for blood to flow,” added Dr. Belkhair.
Dr. Belkhair explained that while the exact cause of Moyamoya disease is not known, multifactorial inheritance is considered a possible cause because the incidence of the disease is more common in Asian countries, underscoring the significance of HMC’s program.
“We are still trying to understand the mechanism of developing Moyamoya disease. Some researchers believe it could be due to an inherited defect of cerebral blood vessels. The cause may also be related to associated conditions such as Down syndrome and sickle cell disease. This disease primarily affects children, but it can also occur in adults, with the first symptom often being a stroke,” added Dr. Belkhair.
Dr. Ali Ayyad, Senior Consultant, Neurosurgery was the lead surgeon for the recently completed milestone tenth operation. He said surgery is generally recommended for Moyamoya patients with recurrent or progressive TIAs or strokes to prevent further strokes by restoring (re-vascularizing) blood flow to the affected areas of the brain.
“HMC introduced the Brain Re-Vascularization Program in Qatar as a last resort for patients suffering from symptoms of decreased blood flow to the brain. We are the only healthcare provider in the Middle East offering this complex surgery,” said Dr. Ayyad.
“While the re-vascularization surgery is primarily for patients with Moyamoya disease who are at risk of suffering from stroke, it can also be used to treat dissecting or fusiform brain aneurysms that don’t respond to conventional therapy. To date, we have performed nine surgeries on patients with Moyamoya disease and one on a patient with dissecting aneurysm,” added Dr. Ayyad.
Dr. Ayyad said that the surgery, which involves taking blood vessels from the scalp of a patient and then completing a craniotomy (making an opening in the skull) and connecting blood vessels from the scalp to blood vessels on the patient’s brain, has been successful in improving the symptoms of patients and increasing blood going to their brains.
The overall prognosis for patients with Moyamoya disease depends on how rapidly vascular blockage occurs, and to what extent. Dr. Belkhair said if a patient is surgically treated before a disabling stroke, even if the condition is severe, it will improve their life expectancy and reduce their risk of stroke, highlighting the importance of HMC’s Brain Re-Vascularization Program.