Intracerebral hemorrhage after prophylactic revascularization in a patient with adult moyamoya disease

Disappearance of aneurysms associated with moyamoya disease after STA–MCA anastomosis with encephaloduro myosynangiosis

“…These aneurysms are classified as ''peripheral aneurysms'' and ''major artery aneurysms''. 5 Peripheral aneurysms are caused by rupture of the pathological vessels that form a hematoma, and are regarded as pseudo-aneurysms due to their transient appearance on cerebral angiograms. 6 Rupture occurs due to persistent hemodynamic stress on dilated, fragile moyamoya vessels, 7 often occurring in the basal ganglia, thalamus or ventricles.…”

Intraventricular Hemorrhage Long after Successful Encephaloduroarterio Synangiosis in Moyamoya Patient

“…Impairment of the hemodynamic reserves required to change the intracranial perfusion pressure and failure of moyamoya blood vessels due to elevated hemodynamic stress could result in hemorrhage 11,15) . Microaneurysms in moyamoya vessels could also act as sources of cerebral hemorrhage 14) . However, in the majority of cases, recurrent hemorrhages do not result from breakdown at specific weak points, but are rather caused by diffuse vulnerabilities of collateral vessels adjacent to the lateral ventricle 7) .…”

“…Although the precise mechanism of hemorrhage in moyamoya disease remains unknown and no definite preventive treatment has been devised 6) , researchers continue to find better ways of preventing hemorrhage [5][6][7]10,13,15) . Many reports have addressed treatment options for reducing the rates of re-bleeding in hemorrhagic moyamoya disease 4,10,13,15,16) ; however, reductions in re-bleeding incidents in hemorrhagic moyamoya patients after surgical treatment are difficult to assess due to a lack of long-term postoperative follow-up data 14,15) . Nevertheless, bypass surgery is a powerful tool in this area because it likely aids in the prevention of re-bleeding, which increases the blood flow in revascularized collateral vessels and reduces the number of moyamoya vessels 10,13) .…”

“…A prospective randomized controlled trial is now underway in Japan in order to determine the effect of bilateral direct revascularization surgery on patients with adult hemorrhagic moyamoya disease 9,14) . Through these efforts, further development on the integration of knowledge of moyamoya disease would make it possible for clinicians to determine the best strategies for the treatment and prevention of moyamoya disease.…”

“…Moyamoya disease is an unusual form of chronic, occlusive cerebrovascular disease characterized by bilateral stenosis or occlusion at the terminal portion of the internal carotid artery (ICA) and by an abnormal vascular network at the base of the brain 1,3,10,14,16) . There are two types of moyamoya disease: juvenile-onset and adult-onset 1,3,7) , and it has been suggested that these two types are actually clinically distinct entities 7) .…”