Child with Rare Disease Undergoes Life Saving, First-of-its-kind Surgery at Medcare Orthopaedics & Spine Hospital
- The child suffered fromarare geneticconditioncalled Moyamoya disease, causingboth her carotid arteries, delivering blood to the brain, to significantly narrowwith one of them over 90% blocked.
- The child's lifewas successfully savedat Medcare Orthopaedics and Spine Hospital, making her one of the first patients in the UAE to be treated using the novel EDAMS technique
Dubai – July25, 2023: The life of a four-year-old UK national girl, suffering from a rare, progressive cerebrovascular disorder called Moyamoya disease (MMD), has been saved with a noveltechnique for indirect revascularization (restoring blood flow) surgery. The first-of-its-kind surgical procedure in the UAE, performed by Dr. Gopalakrishnan CV, Consultant and Head- Neurosurgery and Spine Surgery at Medcare Orthopaedics and Spine Hospital along with his team,saved the child's life without needing treatment abroad.
Moyamoya is a rare disease characterized by a progressive narrowing of the internal carotid artery, the major blood vessel that provides the brain's blood supply. Research shows that the annual incidence of moyamoya disease is 0·5–1·5 per 100 000 individuals in east Asian countries but as low as 0·1 per 100 000 in other regions, including North America. Although MMD can be initially treated with medication, surgical intervention is required in cases of progressive disease or recurrent symptoms.
Speaking about the seriousness of MMD, Dr. Gopalakrishnan said, "The narrowing of blood vessels leads to the formation of collateral blood vessels that resemble a 'puff of smoke', translating to Moyamoya in the Japanese language. Although Moyamoya disease can be present in children and adults, it is most commonly found among children between the ages of five and 10 years old. The disease is also the most prevalent in East Asian countries.Thus, this patient's case was quite rare."
The young childhad a history of suspected transient ischemic attack, which are strokes that only last a few minutes. During an otherwise regular day of play, she suddenly experienced slurred speech, facial asymmetry, and mild right upper arm weakness.Following an MRI brain and MR angiogram, the doctors discovered significant narrowing of a portion of both internal carotid arteries, with the right artery completely obliterated, consistent with a diagnosis of Moyamoya disease. The diagnosis was confirmed by a 4-vessel digital subtraction angiogram which provides an image of the blood vessels in the brain to detect a problem with blood flow.
Dr. Gopalakrishnan said, "Following the diagnosis, we decided to opt for surgery, whichinvolved combined bypass using the EDAMS (encephaloduroarteriomyosangiosis) technique that would provide us with multiple sources for indirect revascularization."
"There were risks since EDAMSwas not commonly performed in the UAE and up until now, patients had to seek this lifesaving surgery abroad. In fact, this was going to be one of the first attempts to perform the surgery using the EDAMS technique in the UAE," he further added.
According to Dr. Gopalakrishnan, revascularization surgery, such as indirect or direct bypass surgery, is the primary surgical treatment for MMD. With direct bypass surgery, the surgeon connects the superficial temporal artery (STA), which are the terminal branches of the external carotid artery to the cortical branches of the middle cerebral artery providing oxygenated blood to the brain and improving the blood supply.
On the other hand, indirect bypass or EDAMSis a procedure where the surgeon uses the branches of the superficial temporal artery and a temporalis muscle flap,and places them directly on the surface of the brain.This helps the brain create new blood vessels, triggered by a lack of oxygenated blood. This procedure was augmented by multiple cranial holes to improve the chances for collateral blood flow by providing a conduit for external blood supply on to the brain surface.
The patient underwent EDAMS procedure for the arteries on both sides, as she could not undergo a direct bypass since the calibre of her vessels was very small. More than often in children the vessels are not large enough to sustain a direct bypass.
Speaking about the experience, the mother of the patient said, "We are grateful to Dr. Gopalakrishnan and his team for the outstanding care they provided to our daughter. Their expertise, compassion, and dedication gave me hope and strength throughout the entire process. Thanks to their skilled interventions, my daughter's life has been saved, and she can now look forward to a brighter future. We are eternally grateful for their unwavering support and care."
Commenting on the medical breakthrough, Dr. Gopalakrishnan said, "We are extremely proud of what we have accomplished, and the success of this case is a testament to massive leaps that the UAE has made in medical science and technology in recent years. Parents of patients can rest easy knowing that their children no longer need to travel abroad for further treatment, because we can save them right here, at home."
On the last follow-up visit, Dr. Gopalakrishnan confirmed that the patient is healthy and back to normal life.
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About Medcare:
Medcare is the premium private healthcare provider under the parent group, Aster DM Healthcare. Operating leading state-of-the-art Hospitals, including Medcare Multi-specialty Hospital in Dubai and Sharjah, Medcare Women & Children Hospital, Medcare Orthopaedics and Spine Hospital, and 20 medical centres in the UAE, Medcare has established a strong presence in the UAE.
Medcare is dedicated to offering premium integrated health services in accordance with the highest quality. From talent to technology to facilities and treatment, Medcare maintains the highest possible standards in healthcare delivery. All Medcare hospitals and medical centres are accredited by the Joint Commission International (JCI), which is considered the gold standard in global healthcare. Apart from this, Medcare facilities have won several certifications.
What sets Medcare apart is its exceptional multi-cultural, multi-lingual team of doctors who have received extensive training from some of the top-notch medical institutes around the world. Using a multidisciplinary approach, the Medcare team provides optimal, evidence-based treatments to patients, with the support of trained nurses, dieticians, rehabilitation therapists and technologists. Living by its simple promise "We'll Treat You Well", Medcare's team is fully committed to providing high-quality, personalized medical care to every patient. For more information on Medcare visit http://www.medcare.ae or follow @Medcareae
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