DOGRA HERALD BUREAU
JAMMU, Aug 12
In a groundbreaking medical achievement, Indraprastha Apollo Hospitals has successfully treated a 17-year-old boy from Nepal suffering from diffuse cerebral proliferative angiopathy (CPA). This exceptionally rare and complex condition, with fewer than 100 cases reported till date, involves a dense network of capillaries interwoven with brain tissue, setting it apart from classical arteriovenous malformations (AVMs). This vascular malformation alters blood hemodynamics by shunting blood away from the eloquent brain cortex, leading to headaches and neurological deficits. The patient had experienced progressive weakness in his right limbs, recurrent seizures, and severe headaches for four years. Despite being on five different anti-epileptic drugs, his seizures persisted, leading to significant drowsiness. Upon admission, he exhibited right hemiparesis,a handgrip strength of less than 50%, and was barely able to walk without support. MRI and digital subtraction angiography (DSA) confirmed the diagnosis of diffuse left cerebral proliferative angiopathy. Given the complexity of CPA, Dr. Gaurav Tyagi , Consultant , Neurosurgery , Indraprastha Apollo Hospitals performed an indirect cerebral revascularization procedure known as Encephalo-Duro-Arterio-Pial-Synangiosis (EDAPS) which is commonly done for Moya Moya disease. Notably, there have only been 8 reported cases of this procedure being used for CPA. This innovative technique involved reinforcing the brain’s blood supply using the scalp artery (superficial temporal artery), the dura (brain covering), and pericranial tissues (subcutaneous tissue of the scalp).These tissues were placed over the brain surface to create alternative blood supply channels to the affected areas.
The four-hour surgery was completed without complications, and the patient was discharged on the fifth day post-operation without any new deficits. Two weeks after surgery, he remained symptom-free, with control of his seizures. Adjustments to his medications made him more alert, and he is currently undergoing rehabilitation for residual weakness.
Dr Gaurav Tyagi,Consultant, Indraprastha Apollo Hospitals,said,”It was an honor to treat this young patient and witness his remarkable recovery. Diffuse cerebral proliferative angiopathy (CPA) is an extremely rare and complex condition, and the success of this treatment highlights the advanced capabilities of our Vascular neurosurgery team at Indraprastha Apollo Hospitals. The collaborative effort was crucial and involved Dr. Nishchint Jain, our Interventional Neuroradiologist, who performed the cerebral angiography, conducted a detailed literature review, and assisted in the decision-making process. Additionally, Dr. P.N. Renjen, Senior Consultant in Neurology, reviewed the patient’s seizure medications and played an instrumental role in guiding the entire treatment. The innovative Encephalo-Duro-Arterio-Pial-Synangiosis (EDAPS) procedure we employed is a testament to our commitment to pioneering new techniques and providing evidence-based treatment in the field of neurosurgery. I had the pleasure to visit the family during a trip to Nepal and it was heartwarming to see him doing well. Seeing the patient experience early improvements in his quality of life post-surgery is immensely gratifying. The effects of the surgery will come over a long period of time, but even if we are able to halt the progression of the disease, it is a victory for our effort. This case reinforces our dedication to delivering world-class care and pushing the boundaries of medical science.”
