Effect of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease complicated with ruptured aneurysm

Abstract

Objective To investigate the safety and efficacy of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease with ruptured aneurysm. Methods Five patients with moyamoya disease or Moyamoya Syndrome complicated with ruptured aneurysms (5 aneurysms) were treated at Department of Neurosurgery, Henan Provincial People's Hospital from June 2016 to March 2018. All patients underwent extracranial and extracranial revascularization combined with craniotomy for aneurysm clipping. Five patients were followed up after operation. The results of follow-up were as follows: digital subtraction angiography (DSA) or perfusion weighted imaging (PWI) was used to evaluate the long-term cerebral revascularization and the effect of aneurysm. The recovery of neurological function was evaluated by modified Rankin scale (mRS) and activities of daily living scale (ADL). Results The operations of all 5 patients were successful. Intraoperative fluorescence angiography showed that the intracranial aneurysm did not develop and the bridge vessels were anastomosed unobstructed. No new blood foci were found in 5 patients with CT after operation and there were no complications such as infection, new infarction or bleeding. The follow-up time of 5 patients was 6 to 21 months, with an average of 17.6±1.7 months. DSA showed that the aneurysm did not develop and the bridge vessels were unobstructed in 5 patients at 6 months after operation. During the follow-up period, none of the 5 patients had any new neurological deficit symptoms, and there was no hyperperfusion hemorrhage or large-area cerebral infarction. At the last follow-up, the mRS of 5 patients was 0-3, with an average of 1.4±1.0. The ADL of 5 patients was 55-90, with an average of 76±12 at the last follow-up. Conclusion Cerebral revascularization combined with craniotomy seems safe and effective in the treatment of moyamoya disease with ruptured aneurysm. Key words: Moyamoya disease; Aneurysm, ruptured; Microsurgery; Cerebral revascularization; Treatment outcome