Issue link: https://viewer.e-digitaledition.com/i/1243731
ADvANCED CEREBROvA SCUl AR AND ENDOvA SCUl AR SURGICAl TECHNIQUES AND TECHNOlOGy FOR COMPlE X CA SES BRING PATIENTS IN CENTR Al PENNSylvANIA NE W HOPE. BY CARI WADE GERVIN "A PUFF OF smoke." That's the translation from Japanese of the word Moyamoya, which is also the name of a rare cerebrovascular disease. The blocked arteries at the base of the brain give the appearance of a puff of smoke on an angiogram, but that charming description belies the danger of the progressive disease that can first present as a series of strokes or transient ischemic attacks. Successful treatment of Moyamoya disease ultimately requires cerebral revascularization with direct cerebral bypass — a surgery that Ephraim W. Church, MD, assistant professor of Neurosurgery, Radiology and Neurology and director of the Cerebral Revascularization Program at Penn State Health Milton S. Hershey Medical Center, specializes in. "It's a microsurgery that I find both challenging and rewarding," Dr. Church says. "And it's a very effective surgery — we can bring the stroke risk from about 10% per year down to approximately 5% for the remainder of the patient's life, and these patients can go on to live normal, healthy lives." Dr. Church and his team at Penn State Health Neurosurgery have been using the latest microsurgery technology to conduct the bypass surgeries — around two times a month to treat Moyamoya — numbers that Dr. Church says are increasing. The surgery uses a microscope to magnify 1-millimeter vessels 20 times. Dr. Church then uses a suture that's about a third of the diameter of a human hair to connect a healthy vessel directly to a vessel in the brain, bypassing the narrowed or occluded vessel. "It's a microscopic, reconstructive surgery to create a route for blood around the block- age," Dr. Church says. "It requires good microsurgical technique, intense concentration and creative thinking." A SPECTRUM OF TREATMENT Penn State Health Neurosurgery is just one of a few programs in the country that performs the direct bypass surgery, which is also used to treat carotid and intracranial stenosis, occlusion from other etiologies like athero- sclerotic disease and complex brain aneurysm reconstruction, in which an aneurysm can't be treated with traditional techniques. Dr. Church, who completed his residency at Penn State Health, returned to the hospital last fall, after a fellowship at Stanford University Medical Center, to create and lead the Cerebral Revascularization Program. "It's a wonderfully collegial department," Dr. Church says. "And it offered the opportunity to build something new that we didn't have before. This was something we didn't really have in this region." And, true to Penn State Health's commit- ment to providing a multidisciplinary care Penn State Health Neurosurgery Tackles Rare Diseases 1 0 1 0❱❱❱❱❱ S P E C I A l F E A T U R E