Ruptured Intracranial Aneurysms Associated With Moyamoya Disease  -Three Case Reports-

Arai, Yoshikazu; Matsuda, Ken; Isozaki, Makoto; Nakajima, T; Kikuta, Ken-ichiro

doi:10.2176/nmc.51.774

Cited by 25 publications

(8 citation statements)

References 11 publications

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“…However, conservative treatment is controversial. Although, some reports have suggested that aneurysms in the collateral circulation of moyamoya disease resolve spontaneously without any treatment [2], most recommend treatment given the hemodynamic stress and high flow in these collateral arteries, the high morbidity and mortality observed with recurrent bleeding and the unpredictable outcome of conservative management [8].…”

Section: Discussionmentioning

confidence: 99%

“…These presentations are the result of an increased propensity for aneurysm development and the fragility of the vessels encountered with this disease [3,7]. The management of patients with hemorrhagic presentations remains controversial [2,7,11]. The incidence of aneurysm formation within the moyamoya adult population is 3-14%, and represents a major potential hemorrhagic risk for these patients [1,3].…”

Section: Introductionmentioning

confidence: 99%

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Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease

Daou

Chalouhi

Tjoumakaris

et al. 2015

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease

Daou

Chalouhi

Tjoumakaris

et al. 2015

Journal of Clinical Neuroscience

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“…reported one case of ruptured thalamoperforator vessel pseudoaneurysm, which disappeared without re-rupture on 1-year angiogram. [2] All these reports, however, involve aneurysms which were discovered post-rupture and were resolved by the time of follow-up angiography. In our case, persistence and increased prominence of the pseudoaneurysm over the course of a year prior to treatment would strongly indicate that ultimate resolution was in fact a result of revascularization rather than a spontaneous phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

et al. 2014

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Background:Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery–middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.Case Description:Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.Conclusions:A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.

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“…In recent years, MMD with intracranial aneurysm has been recognized more frequently, especially in patients with a hemorrhagic type. Aneurysms located in the posterior circulation have been estimated to occur in approximately 50-60% of cases with MMD, of which the basilar tip aneurysm was the most common and basilar trunk aneurysm was very rare (3). Moreover, either endovascular treatment or cerebral revascularization was chosen as a surgical strategy for such patients.…”

Section: Introductionmentioning

confidence: 99%

Combined extracranial-intracranial bypass surgery with stent-assisted coil embolization for moyamoya disease with a ruptured wide-necked basilar trunk aneurysm:a case report

Jiang

Ni²,

Lei³

et al. 2014

Turkish Neurosurgery

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A ruptured wide-necked basilar trunk aneurysm is uncommon in patients with moyamoya disease. The optimal treatment is unclear. We report a safe and beneficial treatment modality for moyamoya disease with aneurysms located in the posterior circulation.A 37-year-old man presenting with subarachnoid hemorrhage was admitted to our hospital. Emergent cerebral angiography demonstrated moyamoya disease associated with a wide-necked basilar trunk aneurysm. We performed bilateral extracranial-intracranial bypass surgeries prior to stent-assisted coil embolization of the aneurysm after the acute phase. No complication occurred and the patient was discharged with no neurological deficit. Follow-up digital subtraction angiography (DSA) performed 6 months after the surgery showed that all the anastomosises were patent and bilateral collateral vascular compensation was fully established with no recanalization of the basilar trunk aneurysm post embolization.We also found that high-flow bypass did not contribute to cerebral revascularization as imagined despite the good patency.Combined extracranial-intracranial bypass surgery with endovascular treatment proved to be an efficient therapeutic modality for moyamoya disease with aneurysms located in the posterior circulation. High-flow bypass surgery was not essential due to the inefficiency and the high risk of postoperative cerebral hyperperfusion syndrome. KEywOrds: Extracranial-intracranial bypass, Coil embolization, Moyamoya disease, Basilar trunk aneurysm ÖZMoyamoya hastalıklı kişilerde rüptüre geniş boyunlu baziller trunkus anevrizması nadirdir. Optimum tedavi açık değildir. Posterior dolaşımda anevrizmalar bulunan moyamoya hastalığı için güvenli ve faydalı bir tedavi modalitesi bildiriyoruz.Subaraknoid kanamayla gelen 37 yaşında bir erkek hastaneye yatırıldı. Acil serebral anjiyografi geniş boyunlu bir baziller trunkus anevrizmasıyla ilişkili moyamoya hastalığı gösterdi. Akut fazdan sonra anevrizmanın stent yardımlı sarmal embolizasyonu öncesinde bilateral ekstrakraniyalintrakraniyal bypass cerrahisi gerçekleştirdik. Herhangi bir komplikasyon oluşmadı ve hasta nörolojik defisit olmadan taburcu edildi. Cerrahiden 6 ay sonra yapılan takip dijital subtraksiyon anjiyografisi (DSA) anastomozların açık olduğunu ve embolizasyondan sonra baziller trunkus anevrizmasının rekanalizasyonu olmadan bilateral, kollateral vasküler dengeleyici dolaşımın tam olarak tekrar oluştuğunu gösterdi. Ayrıca yüksek akışlı bypass işleminin, iyi açıklığa rağmen serebral revaskülarizasyona tahmin edildiği kadar katkıda bulunmadığını izlendi.Endovasküler tedaviyle kombine ekstrakraniyal-intrakraniyal bypass cerrahisi, posterior dolaşımda anevrizmalar bulunan moyamoya hastalığı için etkin bir terapötik modalite oldu. Yüksek akışlı bypass cerrahisi, etkin olmaması ve yüksek postoperatif serebral hiperperfüzyon sendromu riski nedeniyle şart değildir.

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Ruptured Intracranial Aneurysms Associated With Moyamoya Disease -Three Case Reports-

Cited by 25 publications

References 11 publications

Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease

Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease

Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

Combined extracranial-intracranial bypass surgery with stent-assisted coil embolization for moyamoya disease with a ruptured wide-necked basilar trunk aneurysm:a case report

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