A Treatment Strategy for Basilar Bifurcation Aneurysm Associated with Moyamoya Disease: A Case Successfully Treated by Combined STA-MCA Anastomosis and Stent-assisted Coil Embolization

Abstract

Objective: A case of basilar bifurcation aneurysm associated with unilateral moyamoya disease (MMD) treated by stentassisted coiling (SAC) following bypass surgery is reported. Case Presentation:The patient was a 41-year-old man with a basilar bifurcation aneurysm associated with left unilateral MMD. Treatment was indicated because the aneurysm showed a gradual increase in size. The left middle cerebral artery (MCA) territory was revealed to have reduced cerebrovascular reactivity although the area was supplied through collateral channels from the left posterior cerebral artery (PCA). A left superficial temporal artery (STA)-MCA anastomosis was performed first, and SAC was performed after 3 month interval. DSA performed 1 year after the endovascular procedure showed progressive occlusion of the aneurysm although the immediate angiographic result was dome filling. Conclusion:An aneurysm associated with MMD located in a major vessels may be treated effectively with a combination of bypass surgery and SAC.