Rare Neurological Condition Treated With Brain Bypass Procedure

Cathy Golden, 44, of Milwaukee, suffered from painful headaches, parts of her face or fingers would go numb, and she would have trouble finding her words.

“The headaches would wake me up in the middle of the night,” Cathy said. “I knew they weren’t migraines, but it felt like no doctor understood me.”

The symptoms progressed quickly, and Cathy had to resign from her position as a student assignment manager in the Milwaukee Public School District. After two years of visiting different neurologists, Cathy was diagnosed with Moyamoya disease, a rare neurological condition. Moyamoya is caused by blocked arteries at the base of the brain. People living with the disease are at an increased risk for strokes, blood clots and seizures.

“With Moyamoya disease, the brain is basically starved of blood,” said Raphael Sacho, MD, a neurosurgeon at Froedtert Hospital. “This condition is rare, so the diagnosis is often missed, and many physicians don’t know enough about Moyamoya or its management.”

Cathy had been told medical management of her symptoms was her only option. It wasn’t until Cathy met with Dr. Sacho that she became hopeful.

Cathy Golden sought care at Froedtert Hospital after being diagnosed with Moyamoya disease.

“It was such a relief when Dr. Sacho said that he could fix me,” Cathy said. “I was overjoyed.”

Dr. Sacho performed a procedure called a brain bypass on the left and right sides of Cathy’s brain. A bypass uses arteries from the scalp to reroute blood flow around the areas that are blocked. The surgeon can perform a direct or indirect bypass — or a combination of both, which is what Dr. Sacho typically performs.

In a direct bypass, the artery is directly connected to the artery of the brain by tiny sutures, immediately improving blood flow. In an indirect bypass, the artery is laid onto the surface of the brain to form a new blood supply within three or four months.

“Growth factors stimulate the blood vessels to plug into the brain and develop new collaterals,” Dr. Sacho said.

Dr. Sacho describes a brain bypass with this analogy: “Think of a tree. It has a trunk which produces branches. Moyamoya is a blockage in the trunk. In a bypass, we take a healthy root from below the trunk and connect it to the branches and leaves, directly or indirectly.”

Since her surgeries, Cathy has been able to return to work. She has regained her energy, and her headaches are gone.

“Simple things, like watching TV or driving, don’t trigger a headache anymore,” Cathy said.

She is grateful to have found Dr. Sacho and the rest of her care team at Froedtert Hospital when she did.

“They listened to me when I felt like no one else would,” Cathy said. “I trusted them, they took care of me, and they gave me my life back.”

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Neurosciences