A Novel Approach to Brain Surgery

A Novel Approach

At just five years old, Ava Menefee was suffering frightening stroke-like episodes called “transient ischemic attacks” (TIAs). In these episodes, one side of her face would temporarily droop, or she'd lose sensation in one hand.

Ava’s condition, called moyamoya (Japanese for “puff of smoke”), is when the brain fails to develop the large blood vessels it needs, instead building fragile, smoke-like clusters of blood vessels. Without treatment, Ava’s TIAs would likely escalate to full-blown strokes, causing lasting brain damage.

After an initial surgery to fix her condition failed, Ava's parents were told another brain surgery was impossible. Feeling desperate, they searched for a second opinion,

A Novel Approach

finding Lucile Packard Children’s Hospital Stanford and Gary Steinberg, MD, PhD, one of the world's foremost experts in surgical repair of moyamoya.

Ava’s first failed surgery had used up the scalp arteries and muscle normally used in repair of moyamoya. But Dr. Steinberg offered a bold plan. "When all else fails,” he says, “you try this."

Steinberg and colleague Sanjeev Dutta, MD, proposed stretching a network of blood vessels in the abdomen up to Ava's brain. They would leave the vessel network attached to its blood supply in the torso and tunnel the blood vessels under the skin along one side of Ava's neck to the surface of her brain.

A Novel Approach

To assist in the surgery, Steinberg brought in Dr. Sanjeev Dutta, a specialist in minimally-invasive pediatric surgery. It worked. Ava's TIAs have become much less frequent and severe, a good sign that new blood vessels are beginning to form in her brain.

"Ava's prognosis is excellent for living a normal life," Steinberg says.

The uncommon procedure, and the teamwork it required between different surgical specialties, provide "a perfect example of the type of collaboration we can accomplish at Packard Children's," says Dutta.

A Novel Approach

Two years later, Ava is thriving.

"She's the toughest, bravest person I know," says her mom. "We're just fortunate to have a facility like Packard Children's so close. We know we're in the very best hands."