Due to the lack of medicines for its treatment, the oncologists opted for surgical intervention to facilitate uninterrupted blood flow to the brain

Apollo Proton Cancer Centre, the first and only Proton Therapy Centre in South Asia & the Middle East performed Asia’s first brain bypass surgery on twin 8-year-old children from the Netherlands. The integration of advanced technology and expertise at APCC helped the children to undergo surgery and recover quickly.

The first case to be witnessed in Asia of Moya Moya disease–a rare blood vessel (vascular) disorder in which the carotid artery in the skull is blocked or narrowed–reduces blood flow to the brain.The condition was diagnosed in eight-year-old twin girls. Over the years, one of the twins developed vague symptoms like jerky movements in the right hand and leg. The persistent symptoms concerned parents who sought for neurologist’s opinion. The requested MRI scan of the brain showed that the blood supply to the brain was significantly compromised on both sides of the brain, especially on the left. These episodes originally thought of as seizures were a form of multiple mini-strokes often called limb-shaking epilepsy, which signifies compromised blood circulation to the brain. Since the girls were twins, both were scanned and showed similar MRI findings. The children were examined by a senior neuro-physician, who diagnosed this condition as Moya Moya disease which is a relatively uncommon disease and even rarer in identical twins. For the best possible surgical intervention, he referred the children to Apollo Proton Cancer Centre, Chennai.

At APCC, we aim to bring together the best minds in oncology; deliberate the emerging trends in cancer management and their impact on clinical practice thus providing a ray of hope to 3.5 billion from over 147 countries.

The neuro-sciences team led by Dr. Roopesh Kumar, Senior Consultant, Neurosurgeon, Apollo Proton Cancer Centre further examined the children using MRI brain perfusion, with a special sequence using acetazolamide challenge, that helps in identifying the areas at risk in the brain for impending stroke. Stereotypically, the findings were almost similar in both twins and the left side was more affected than the right. Due to the lack of medicines for the disease, the team of doctors offered surgical intervention via a brain bypass surgery wherein the blood supply from the skin of the head would be diverted into the brain through a window created on the skull bone. This would facilitate uninterrupted blood flow to the brain without the risk of developing strokes. This procedure was advised for the twin children. The surgery, STA-MCA bypass, was performed initially for the symptomatic child. The procedure went on for nearly five hours. And on the second day, the other child also underwent a similar procedure. Both procedures showed successful outcomes, and the patients recovered well. A thorough check-up after three months of surgery was conducted to ensure that the twins were healthy. The consecutive scans showed improved blood circulation on the left side of the brain.

Dr. Roopesh Kumar, Senior Consultant, Neurosurgeon, Apollo Proton Cancer Centre, said “When we first met the two young girls with Moya Moya disease, the team was heartbroken yet determined to do the very best to save those two precious lives. The surgery to ensure good blood flow in the left brain and reduce the chances of strokes to a minimum, was successful and was well adapted to the body. I am extremely delighted with their recovery and glad that our efforts to address Moya Moya disease were successful. The timely decision to perform this complex surgery helped in saving lives at the right time. At APCC, high-risk cases are managed in a specialised tertiary centre with excellent facilities. The advanced surgical techniques and availability of technology in combination with expertise improves the chances of saving a patient’s life even in critical complications.”

Dr. R.Lakshmi Narasimhan, Senior Consultant Neurologist, Firstmed Apollo Hospital, said, “I saw the twin girls, both of them post covid, and I suspected covid related vasculopathy. As we evaluated one of the twins already had a stroke in the carotid artery territory one of the major blood vessels supplying the brain, and the other had impending symptoms of a stroke. Investigations revealed an alarming presence of blockage of both the carotid arteries on both sides of the brain in the twins suggestive of a rare are Moya Moya disease requiring urgent revascularisation. I had referred them to Dr.Roopesh and extremely happy to see both of them doing well after surgery.”

Ms Preetha Reddy, Executive Vice-Chairperson, Apollo Hospitals Enterprise Ltd, said,
“First and foremost, I would like to congratulate the team on the successful surgery to address the moyamoya disease. As rare and unique the case may be, Apollo Hospitals have always at forefront with advanced technology and experienced team to come to rescue of all kinds of patients. The two girls, twins and genetically connected by moyamoya disease, required urgent yet thoughtful and planned treatment to ensure live safety. Delivering quality healthcare has always been Apollo’s forte and we will continue to save lives with our Tender Loving Care. I wish both the young girls a happy and healthy life ahead.”

The Apollo Proton Cancer Centre has the state-of-the-art Cancer Surgery Unit. It offers specialized 360-degree care with the most advanced technical system for complex surgeries. The Apollo Proton Cancer Centre is committed to providing patients with an exceptional experience using cutting-edge treatment options.