Prevention of rebleeding plays an important role in the treatment of hemorrhagic moyamoya disease, because rebleeding results in high mortality and morbidity. We discuss possible treatment for patients with moyamoya disease accompanied with distal choroidal artery aneurysms and review the literature to summarize clinical treatment and mechanisms. The cases of three male patients who suffered from intraventricular hemorrhage are presented. Computed tomography (CT) and digital subtractive angiography (DSA) revealed that bleeding was believed to be caused by ruptured aneurysms originating from distal choroidal artery aneurysms. Two patients successfully underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) and the obliteration of the aneurysm. The follow-up DSA or CT scan demonstrated that the aneurysms completely disappeared with the patency of the reconstructed artery. Neither of the patients experienced rebleeding during the follow-up period (up to 34 months). Given conservative treatment, the third patient experienced recurrent hemorrhages 4 months after the first ictus. This study describes treatment for moyamoya disease accompanied with distal choroidal artery aneurysms. Our experience suggests that cerebral revascularization combined with obliteration of the complicated distal aneurysm in the same session is a possible treatment.

Background: By definition, a cavernous sinus is a vascular plexus. A hemangioma is a vascular tumor which is rich in vascular plexus and caused by vascular deformity or tumor-like proliferation. Radiosurgery can effectively control the growth of smaller cavernous sinus hemangiomas (CSHs). This paper aimed to quantify the MRI characteristics of CSHs which provided a basis for further treatment. Methods: A retrospective analysis was conducted of the MRI characteristics of 133 cavernous sinus lesion patients between January 2006 and December 2009, and none of them was diagnosed without histology. Two groups were set apart according to the pathological results: a CSH group (24 patients) and a non-CSH group (109 patients). The latter was further divided into 3 categories: a meningioma group (33 patients), a neurilemmoma group (37 patients) and a miscellaneous group (39 patients). A single-factor χ² analysis was performed to analyze the data on the 12 MRI characteristics. Results: T2-weighted ultrahigh signal, signal uniformity, dumbbell-like appearance and infiltration of the sellar region were considered statistically significant for the differentiation of CSHs from non-CSHs. If these 4 items served as the diagnostic criteria, the sensitivity, specificity and accuracy was 87.5, 96.3 and 94.7%, respectively. Conclusion: Smaller CSHs can be treated by radiosurgery directly, without performance of a pathological biopsy.

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