Abstract
Prevention of rebleeding plays an important role in the treatment of hemorrhagic moyamoya disease, because rebleeding results in high mortality and morbidity. We discuss possible treatment for patients with moyamoya disease accompanied with distal choroidal artery aneurysms and review the literature to summarize clinical treatment and mechanisms. The cases of three male patients who suffered from intraventricular hemorrhage are presented. Computed tomography (CT) and digital subtractive angiography (DSA) revealed that bleeding was believed to be caused by ruptured aneurysms originating from distal choroidal artery aneurysms. Two patients successfully underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) and the obliteration of the aneurysm. The follow-up DSA or CT scan demonstrated that the aneurysms completely disappeared with the patency of the reconstructed artery. Neither of the patients experienced rebleeding during the follow-up period (up to 34 months). Given conservative treatment, the third patient experienced recurrent hemorrhages 4 months after the first ictus. This study describes treatment for moyamoya disease accompanied with distal choroidal artery aneurysms. Our experience suggests that cerebral revascularization combined with obliteration of the complicated distal aneurysm in the same session is a possible treatment.
Highlights
Moyamoya disease is a chronic cerebrovascular disorder characterized by idiopathic stenosis or occlusion of the bilateral terminal internal carotid arteries
Some experts suggest that endovascular intervention is a suitable strategy for the management of distal choroidal artery aneurysms associated with moyamoya disease [8,9,10]
In this report, we describe three patients with intraventricular hemorrhage (IVH) secondary to distal aneurysms associated with moyamoya disease
Summary
Moyamoya disease is a chronic cerebrovascular disorder characterized by idiopathic stenosis or occlusion of the bilateral terminal internal carotid arteries. Moyamoya disease associated with distal choroidal artery aneurysms is rarely encountered. There is no unified treatment for patients with distal choroidal artery aneurysms associated with moyamoya disease. Three cases of distal choroidal artery aneurysms associated with moyamoya disease were encountered in our study and are described in this report. In order to explore the feasible management of distal choroidal artery aneurysms in patients with moyamoya disease, we performed a literature review on this uncommon but challenging condition [10,12,14,15]. The patient had an uneventful postoperative course without fixed deficit, and follow-up DSA performed at 21 months after surgery showed no residual aneurysm; an enlarged STA suggested good distal function of the bypass (Figure 2E,F,G,H). But his family declined and the patient was managed conservatively
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