We met Dr. Steinberg and his nurse Teresa yesterday (11/7). They believe Bethel's involuntary movements are hemiballistic and linked to Moyamoya. In fact, some of their patients have similar spells and were resolved after surgery. After reviewing Bethel's angiogram, MRI's and CT's performed at Stanford, Dr. Steinberg is recommending surgery on the right side for now because it is the most severe. He will perform a combination of a direct and indirect bypass for the surgical procedure. For the direct bypass an arterial branch from the temporal artery is sutured to a brain surface artery, and for the indirect bypass he will overlay a scalp artery over the surface of the brain which overtime should grow.
STA-MCA Surgical Procedure and Diagrams
He plans to continue to observe the left side in 6 months to evaluated the progression of Moyamoya. There are signs of narrowing on the left, but otherwise she has good blood flow on that side. The Xenon CT test uses diamox to dilate the arteries during the scans, and she showed good perfusion and augmentation on the left. Approximately 75% of Dr. Steinberg's patients that receive unilateral treatment show progression of the disease on the other side.
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