Coil embolization for post-bypass aneurysm of middle meningeal artery for moyamoya disease – preservation of transdural anastomosis

Abstract

Background: Middle meningeal artery (MMA) pseudoaneurysm following revascularization surgery for moyamoya disease (MMD) is rare. Case Description: Here, a 29-year-old man presented with an MMA pseudoaneurysm after he underwent revascularization surgery (superficial temporal artery-to-middle cerebral artery bypass and encephalo-duro-myoarterio-pericranial synangiosis) for hemorrhagic MMD. At 3 months post-surgery, digital subtraction angiography showed a pseudoaneurysm in the right MMA. Transdural anastomosis to the parietal and occipital lobes was opacified at the distal MMA of the pseudoaneurysm. Intra-aneurysmal coil embolization was performed for preservation of transdural anastomosis. The postoperative course was uneventful. At 1 month post-embolization, angiography revealed an entirely occluded pseudoaneurysm. Conclusion: An increase in blood flow in the MMA due to bypass surgery may accelerate aneurysm development by increasing the hemodynamic stress. This case suggested that intra-aneurysmal embolization may be a potential treatment.

A Ruptured Aneurysm of the Transdural Anastomotic Artery Occurring at the Temporal Base in Moyamoya Disease: Case Report and Literature Review

“…Alternatively, hemostatic treatment or aneurysm embolization by endovascular therapy should be considered first if it is possible under the emergent situation. 15 )…”

Post-traumatic Middle Meningeal Artery Pseudoaneurysm Treated With Endovascular Coil Embolization

“…As such, endovascular embolization is considered first-line treatment of pseudoaneurysms in the absence of significant mass effect [ 14 , 19 ]. Modalities can include liquid embolic agents such as Onyx [ 12 , 16 ] or N-butyl cyanoacrylate [ 6 , 11 , 13 ] as well as endovascular coiling [ 2 , 3 , 5 , 14 , 17 , 20 ]. A long-term follow-up is not well characterized with regard to the risk of recurrence or recanalization, thus no specific method of embolization can be recommended at this time.…”