It is very well known that surgery is the only treatment for moyamoya. The surgery for moyamoya can be performed in various ways depending on the severity of the condition, the type of patients involved because some mode of surgery is more suited for children while others are more suited for adults and the stage of the disease. The surgical procedure can be broadly classified into three categories, direct revascularization, in direct revascularization and combined treatment. The direct revascularization process involves the direct stitching of the scalp artery to the brain artery to create a bypass and direct flow of blood into the brain, whereas indirect revascularization process focuses on increasing blood flow with time in a stable manner, here the artery beneath the skull is connected to the surface of the brain via a small temporal opening, thereby facilitating the growth of arteries with time. Sometimes, multiple holes are burred in the scalp to allow the growth of new vessel from the bone to the scalp.
How Long Does Moyamoya Surgery Take?
The overall stay of the patient under supervised care before and after the surgery takes approximately 3 days of hospitalization plus or minus 2 days depending on the improvement rate as each patient has different recovery rate and different medical conditions other than moyamoya itself. It is very important that the patients be well hydrated before the surgery to prevent hypovolemia and to do that the patients are admitted the evening before the surgery for vigorous intravenous hydration. It is advised to show up 2 hours before the time of the surgery in order to prepare and complete pre-surgical tasks. Along with this, an anesthesiologist will need some time to provide with risks and procedure involved in giving anesthesia.(1)
The entire duration of the surgery depends on the type of bypass and the no. of bypasses made but the approximate time for the surgery lies somewhere close to 3 hours. These 3 hours can be broadly classified into 7 steps.
- Prepping up the patient
- A skin incision is made
- Arranging the donor artery
- Prepare craniotomy
- Arrange the receiving artery
- Attach the receiving and the donating artery
- Examine the blood flow
- Carefully close the craniotomy
Once the surgery has been performed successfully, the patient is moved to the post anaesthesia care unit (PACU). It is needed that the blood pressure is tracked for 24 hours post surgery as bleeding may occur from the site where the two arteries are connected. A tube which was used to provide assistance for breathing during surgery is kept until the patient is awake and has recovered from anaesthetic effect. Once the patient is fully awake, they are moved to the neuroscience unit wherein the movement of the body is examined. During this period, a device known as Doppler ultrasound is used to examine the pulse at the site of the incision so as to verify the flow of blood via the new connections. Further, a CT scan is conducted to make sure no other internal injuries such as postoperative bleeding has occurred. They are constantly well hydrated and medicated with aspirin to keep the blood thin. The patient is usually discharged 1-2 days post surgery. Pediatric patients obviously require 24-hour care. In rare and unfortunate scenarios, the newly formed blood vessel may get blocked again. These blockages are known as occlusions and usually occur within 24-72 hours after surgery but have also known to occur months after the surgical procedure. In this case, it is necessary that patients are required to be re-operated.
Overall, just like the advancement of all the worldly technologies, medical advancement allows patients to recover within the minimum time so that they can proceed with their life outside the hospital visits. Newer medical equipment allow for complicated surgeries to be conducted for as little as 3 hours with a total hospital stay of somewhere between 3-5 days. (1)