A rare brain disease was discovered at the age of 34

Iyad, 34 years old from the south of the country, walked around for months with severe headaches and dizziness, but convinced himself that it was a daily load and stress. Only after experiencing repeated cerebral events did it become clear that he suffers from “Moya Moya” – a rare and congenital brain disease, which causes a gradual blockage of the main arteries in the brain and can lead to a stroke and even an immediate life-threatening condition. In the tests conducted at the Hadassah Ein Kerem Hospital, it was determined that his condition required complex and urgent brain surgery.

“At first I convinced myself it was stress and fatigue,” he says, “I didn’t think there was a reason to run for a check-up, but over time the pain became aggressive – there were days I couldn’t function at all.” Only in retrospect did it become clear that the feelings he attributed to routine were an expression of repeated brain events, and that two such events had already occurred.

The diagnosis received was unusual and alarming. Moya Moya is a disease in which the main artery in the brain is gradually blocked, and the body tries to compensate by creating alternative blood vessels. “These are small and weak blood vessels, which do not provide normal blood flow,” explains Dr. Samuel Moskvisi, director of the unit for skull base surgery and brain endoscopy at Hadassah Ein Kerem. “Eventually, they cause repeated strokes, and in some situations also a real danger to life.” According to him, this is an extremely rare disease: “Very few patients are diagnosed with this condition every year. In Israel, no more than five adults are diagnosed with Moya Moya a year.”

In Ayad’s case, it turned out that his condition was already life-threatening. He was urgently referred for brain surgery, after it was determined that any further stroke could end in a severe stroke and even death. The surgery was performed by Dr. Mosquisi, the only one in Israel who performs this type of advanced procedure COMBINE BYPASS – A complex microsurgical operation to restore the blood supply to the brain. ”

To date, Dr. Mosquisi has operated on about 20 patients with Moya Moya. “Since it is a rare disease, medical officials do not always suspect its existence immediately upon the appearance of headaches or minor cerebrovascular events,” he explains. “Thanks to the Moya Moya clinic in Hadassah, and in cooperation between experts in brain catheterization and neurology, such as Prof. Ronen Leker, director of the stroke research and treatment unit, Prof. Jose Cohen, director of the endovascular neurosurgery unit, and Dr. Yoel Schwartzman, a doctor in the neurology department, it is possible to arrive at a complete and accurate diagnosis – and then to operate.” According to him, before complex surgeries of this type, a 3D model is used, which is also used to guide doctors from Hadassah and other hospitals. “Before such an operation, I practice the operation on a dry model, experiment and prepare. It will also be possible to perform the operation in other hospitals on suitable patients – after gaining experience and knowledge of the method.”

During the surgery performed on Iyad, two techniques were combined: a direct connection of an artery from the scalp to a damaged cerebral artery, which allows for an immediate improvement in blood flow, alongside an indirect approach in which tissue rich in blood vessels is attached to the brain, with the aim of encouraging the gradual creation of new blood vessels. “The surgery is complex and delicate,” says Dr. Mosquisi, “we are required to connect a blood vessel about 0.8 millimeters thick to an even thinner blood vessel, using a suture the diameter of a hair. At this time, it is necessary to close the artery that carries blood to the brain and act quickly to reopen it.”

The operation was successful, after which a normal return of the blood supply to the brain was observed. Iyad was released to his home in good condition, and since then he has not suffered from any further stroke. “Already after the operation I felt a change,” he says. “Slowly I came back to myself, without the constant fear that something was going to happen.” Dr. Mosquisi says that he also remembers other cases in which the diagnosis came too late. “There were patients who came to me after multiple brain events, when they had already suffered irreversible neurological damage.”

Today, when he is under medical observation, Ayad wishes to convey a clear message to the public: do not ignore signs. “If something feels unusual – it should be checked,” he says. “I am thankful every day for the fact that I arrived on time and that I received treatment that saved my life.”