Moyamoya surgery: cost of the curative treatment

Moyamoya disease is a rare, chronic disorder of the cerebral arteries. Translated from Japanese, “moyamoya” means “puff of smoke”.

The disease got its name due to the specific view of neogenic blood vessels: in moyamoya large brain arteries become narrow, so the existing smaller arteries widen and new ones grow in order to restore sufficient blood supply.

Moyamoya disease is a rare, chronic disorder of the cerebral arteries. Translated from Japanese, “moyamoya” means “puff of smoke”.

The disease got its name due to the specific view of neogenic blood vessels: in moyamoya large brain arteries become narrow, so the existing smaller arteries widen and new ones grow in order to restore sufficient blood supply.

Neoplastic arteries are not able to provide the brain tissue with a required amount of the arterial blood. In addition, they are too fragile and can rupture causing life-threatening bleedings. Thus, surgical revascularization is the most appropriate treatment option that eliminates anatomical background of the disease.

Who is eligible for the surgery?

Basically, all patients with the confirmed diagnosis are eligible for the surgical treatment. In absence of the appropriate therapy the following clinical manifestations arise:

  • Headaches in the certain head region.
  • Drug resistant seizures.
  • Blurred vision, difficulties in focusing on objects.
  • Numbness and/or muscle weakness in extremities.
  • Uncontrolled movements and hyperkinesis.
  • Speech disturbances.
  • Developmental delay in children.

Medications may alleviate symptoms, but without neurosurgery patients have high risk of intracerebral hemorrhages and multiple strokes development. Young age is not an obstacle. Quite the contrary, children usually show better responses to the revascularization surgery than adults do.

Which examinations are obligatory for the surgery planning?

Visualizing techniques are the basis of the diagnosis making and the subsequent treatment planning. In order to diagnose moyamoya precisely, doctors use the following procedures:

  • MRI and CT scan provide doctor with comprehensive picture of the cerebral tissues and cranial bones state.
  • During the cerebral angiography liquid with the contrast agent is injected intravenously. After entering the systemic circulation, it highlights vessels, so they become visible for the X-rays.
  • Transcranial Doppler ultrasound examination reveals intensity of the regional cerebral blood flow and shows the vessels’ structure.
  • PET, SPECT reflect functional activity of the brain.
  • Electroencephalography reflects electrical activity of the brain.

General preoperative examination is also performed, i.e. blood and urine tests, ECG, etc.

Which surgical techniques are the most beneficial?

Main goal of each surgery type is bypassing the blocked arteries and restoring sufficient blood supply of the cerebral tissue. This procedure is called revascularization. There are two basic types of the revascularization surgeries:

  1. Direct brain revascularization implies creating the connection between the large scalp artery (superficial temporal artery) and the middle brain artery. Cerebral blood flow increases immediately after the procedure performing. Direct brain revascularization is mainly carried out in adults, as manipulations on the tiny blood vessels in children are rather complicated technically.
  2. Indirect brain revascularization is more suitable for children and patients of the younger age. This procedure takes more time, as it implies growing of normal arteries into the cerebral tissue. New normal arteries may spring from scalp arteries (encephaloduroarteriosynangiosis, EDAS) or muscles arteries (encephalomyosynangiosis, EMS). Combination of EMS with EDAS is also possible.

Complicated moyamoya disease may require the urgent life-saving surgery, e.g. in patients with ruptured brain aneurysm or cerebral infarction.

Which clinics offer the most effective surgical treatment?

Investigating the information about hospitals that offer surgical treatment of moyamoya disease, one should pay attention to availability of the necessary diagnostic equipment, number of the surgeries per year, success rates, possibility of undergoing neurological rehabilitation after the treatment completion, etc. As a rule, the most prominent results are demonstrated by:

  • University Hospital of Ludwig Maximilian University of Munich, Germany.
  • Charite University Hospital Berlin, Germany.
  • Tel Aviv Sourasky Medical Center, Israel.
  • University Hospital for Neurosurgery, Salzburg, Austria.
  • University Hospital HM Monteprincipe, Madrid, Spain.

If your native country cannot offer the same level of medical service, it is better to consider treatment abroad. Carefully performed surgery will minimize the risk of moyamoya disease complications, while the unsuccessful intervention poses serious health risks.

Is the cost of treatment affordable for a private payer?

Moyamoya surgery cost differs depending on the country, hospital and doctor, age of the patient, and type of the intervention. Health insurance may cover the expenses, but in a number of cases patients are forced to pay by themselves.

Approximate price for the preoperative examination varies from 1,362 € in India to 1,546 € in Spain, and 1,725 € in Germany. The surgery itself will be as expensive as 13,900 € in Turkey, 16,100 € in South Korea, and 16,600 € in Germany.

In order to avoid overpricing and additional fees for the foreign patients, it is better to use help of Booking Health. Booking Health is the certified medical tourism provider that takes care about all aspects of treatment abroad – from hospital selection to translation of the medical reports after the medical program completion. Leave the request on the website of Booking Health and medical coordinator will contact you the same day.

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