Basilar Artery Aneurysm Research Articles

Abstract 1122‐000124: Dural Arteriovenous Fistula and Implications in Aneurysmal Genesis

Introduction : There is a reported association of cerebral arteriovenous malformations and aneurysms, however, data regarding patients presenting with dural arteriovenous fistulas (dAVF) and aneurysms is limited. Here, we present a patient who was incidentally diagnosed with 2 aneurysms in addition to a dAVF; and her treatment course. Previous to her diagnosis, she denied any and all symptomatology that would prompt further evaluation. Methods : Case description: 60‐year‐old female with history of hypertension, hypothyroidism and gastroesophageal reflux disease who initially presented to an outside hospital after a motor vehicle collision in 2016, at that time she reports being diagnosed with multiple aneurysms; but was lost to follow up. In 2020 she was referred to interventional neuroradiology and underwent diagnostic digital cerebral angiogram. Which reported a 13 × 12 × 13.3 mm left para‐ophthalmic internal carotid artery (ICA) aneurysm with a 7 mm neck. A 5.7 × 7.7 × 6.1 mm basilar tip artery aneurysm with a 5.6 mm neck and a right Cognard type four occipital dAVF, with feeding vessels from the right posterior cerebral artery and right occipital artery and anterograde drainage to the dural sinuses. From the time of diagnosis to the initiation of interventions, patient denied any concerning symptomatology. Treatment was initiated 4 months after diagnostic angiogram. She received 5 days of Dual Antiplatelet therapy (DAPT) with aspirin and Plavix previous to the deployment of a woven endobridge device (WEB™ 8‐3mm) into the basilar tip aneurysm; as this was felt to be the aneurysm with highest probability of rupture. Post‐operative course was unremarkable and DAPT was discontinued. Three months after WEB™ deployment, the patient underwent embolization of the right occipital dAVF with a liquid embolic agent (onyx™). Post operatively, she developed decreased peripheral vision in her left eye, though the rest of her hospitalization was unremarkable. 3 months after embolization, she underwent left para‐ophthalmic artery aneurysm flow diversion with a pipeline™ (4‐18mm) flow diverter, with an uncomplicated admission. She was subsequently evaluated by neuro‐ophthalmology who has reported a stable peripheral left eye left inferior quadrantic defect along with a supertemporal defect in her right eye. Results : Discussion: Interestingly, the patient presented 2 aneurysms, one in the anterior circulation and the most concerning, located in the posterior circulation. One could draw conclusions that the dAVF was associated with the basilar aneurysm. As dAVFs are acquired lesions, it is feasible to assume that there may be an association between both types of lesions, perhaps due to flow or pressure being exerted on weakened vessel walls, thus leading to aneurysmal formation. Conclusions : Conclusion: Because a potential for implication in the flow dynamics of the dAVF in aneurysmal formation. We have opted to use computational fluid dynamics to analyze said flow within the dAVF to better understand the causal relationship between aneurysms and dural fistulae. In the long run research into genesis of aneurysms secondary to coexisting vascular lesions could further elucidate the mechanisms by which aneurysms develop.

Distal Basilar Artery "Umbrella Aneurysm" Treated by Radial Artery Graft Bypass From the External Carotid Artery to Posterior Cerebral Artery and Clip Trapping: 2-Dimensional Operative Video.

A 71-yr-old woman was discovered to have an incidental distal basilar artery (BA) fusiform aneurysm 7 × 5 mm in dimension, shaped like an "umbrella handle" with critical stenosis distal to the aneurysm. The right posterior cerebral artery (PCA) P1 segment was small; the left posterior communicating artery (PComA) was miniscule. Because the natural history of fusiform BA aneurysms is poorly defined, this was equated to a saccular aneurysm, with an estimated 10-yr rupture rate of 29%.1-8 After discussion of alternative treatments, the patient decided upon surgery. Because of inadequate collateral circulation, a bypass to the left PCA was deemed necessary. The aneurysm was exposed by an extended trans-sylvian approach, and the left PCA P2 segment was visualized subtemporally. The left radial artery (RAG) was extracted, and pressure distended to prevent vasospasm. The RAG bypass was sutured first to the P2, and then to the cervical external carotid artery (ECA); the BA aneurysm was then clipped. The proximal anastomosis of the bypass needed revision because of poor flow; a 4-mm punch hole was made to widen the arteriotomy on the ECA. The patient was discharged home with mild memory loss and partial left cranial nerve III palsy. After discharge, she developed a severe left hemicrania, resolved with gabapentin. At 6-wk follow-up, she was asymptomatic, and computed tomography (CT) angiogram demonstrated patency of the bypass. The patient gave informed consent for surgery and video recording. All relevant patient identifiers have been removed from the video and accompanying radiology slides.

Successful retrieval of a retained J guidewire from the right atrium and aorta arch using a self-invented snare device

Guidewire retention during an interventional treatment is a very rare complication that can lead to possible serious complications, such as thrombosis, embolization, sepsis, and perforation. Hence, a retained guidewire must be retrieved as soon as possible. Here, we provide the first report of a case of accidental retention of a 0.035” J guidewire in the right atrium and aortic arch during basilar artery aneurysm embolization. We found that due to the heavier weight of the J guidewire and its hydrophilic-coated layer, it could not be removed using previously reported methods for micro-guidewire retention. Therefore, we constructed a self-invented snare device consisting of a 0.014” micro-guidewire and a 4-Fr MP-A1 catheter and successfully retrieved the J guidewire, thus avoiding open surgery and its associated serious complications. According to our experience, this novel technique described here is quite easy to perform, safe and effective and can avoid serious complications and prevent the need for open surgery.

Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review.

The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature. Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome. The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero.Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence. Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.

Endovascular treatment of vertebral and basilar artery aneurysms with low-profile visualized intraluminal support device

BackgroundThe Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms.MethodsBetween January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results.ResultsWe identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n = 59) or without (n = 5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized.ConclusionsLVIS device of vertebral and basilar artery aneurysms may be an acceptable safety profile and may represent a reasonable treatment option in the short-term. Long-term and larger cohort studies are necessary to validate our results.

Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era

BackgroundCurrently, most basilar artery aneurysms (BAAs) are treated endovascularly. Surgery remains an appropriate therapy for a subset of all intracranial aneurysms. Whether open microsurgery would be required or utilized, and to what extent, for BAAs treated by a surgeon who performs both endovascular and open procedures has not been reported.MethodsRetrospective analysis of prospectively maintained, single-surgeon series of BAAs treated with endovascular or open surgery from the first 5 years of practice.ResultsForty-two procedures were performed in 34 patients to treat BAAs—including aneurysms arising from basilar artery apex, trunk, and perforators. Unruptured BAAs accounted for 35/42 cases (83.3%), and the mean aneurysm diameter was 8.4 ± 5.4 mm. Endovascular coiling—including stent-assisted coiling—accounted for 26/42 (61.9%) treatments and led to complete obliteration in 76.9% of cases. Four patients in the endovascular cohort required re-treatment. Surgical clip reconstruction accounted for 16/42 (38.1%) treatments and led to complete obliteration in 88.5% of cases. Good neurologic outcome (mRS ≤ 2) was achieved in 88.5% and 75.0% of patients in endovascular and open surgical cohorts, respectively (p = 0.40). Univariate logistic regression analysis demonstrated that advanced age (OR 1.11[95% CI 1.01–1.23]) or peri-procedural adverse event (OR 85.0 [95% CI 6.5–118.9]), but not treatment modality (OR 0.39[95% CI 0.08–2.04]), was the predictor of poor neurologic outcome.ConclusionsComplementary implementation of both endovascular and open surgery facilitates individualized treatment planning of BAAs. By leveraging strengths of both techniques, equivalent clinical outcomes and technical proficiency may be achieved with both modalities.

Limited Intradural Anterior Petrosectomy for Upper Basilar Aneurysms: A Technical Note

The extradural anterior petrosectomy is a widely used skull base approach to the upper petroclival region, basilar trunk, and ventral pons. However, there is significant procedure-related morbidity and a complete petrosectomy is required, as the intradural structures are not in view at the time of drilling. We describe an intradural anterior petrosectomy for aneurysms of the basilar trunk and anterior inferior cerebellar artery with intraoperative photographs and artwork to illustrate the approach. A temporal craniotomy is made at the root of the zygoma and middle fossa floor. After opening dura, the trochlear nerve is identified at the tentorial edge. The tentorium is incised posterior to the trochlear nerve and the incision is carried forward across the cisternal segment of the trigeminal nerve toward V3 and the superior petrosal sinus. The petrous apex is identified and drilled lateral and posterior to V3 with a diamond bur. Intraoperative navigation is useful to confirm its location. Once posterior fossa dura is identified, the superior petrosal sinus may be safely cauterized and divided, connecting the tentorial incision with an incision in the posterior fossa dura, and exposing the upper basilar trunk and its branches. Additional bone is removed only as needed. Two patients underwent successful treatment of a basilar trunk perforator and anterior inferior cerebellar artery aneurysm with a subtemporal approach and tailored intradural petrosectomy. The intradural anterior petrosectomy allows limited drilling of the petrous apex and provides sufficient exposure of upper basilar artery aneurysms.

A review on imaging techniques and quantitative measurements for dynamic imaging of cerebral aneurysm pulsations

Measurement of intracranial aneurysm wall motion may refine the current rupture risk estimation. A golden standard for measuring aneurysm pulsation is lacking. The aim is to evaluate magnitudes of aneurysm pulsation as published in current literature. Embase and PubMed were searched for publications containing quantitative measures of cardiac-cycle related cerebral aneurysm pulsation (no date or language restrictions). Eleven studies were included, covering 197 unruptured and untreated cerebral aneurysms. Quantitative pulsation measurements were extracted from the studies. Characteristics of the study population and aneurysms were taken into account, as well as the imaging modality, scanning technique and data processing methods used. A meta-analysis was performed of studies with similar methodologies and individual IA measures and locations. The magnitude of the absolute volume pulsations varied between 14 ± 9 mm3 and 106 ± 123 mm3 and the mean relative volume change varied between 5 and 36%. The meta-analysis revealed a positive correlation between size and absolute volume change. The relative volume change in Basilar artery aneurysms seems smaller. No authors were contacted for original study data and articles only describing visual pulsations were excluded. The variation in methodologies impedes an accurate estimation of the magnitude of IA pulsations. Validation of aneurysm pulsation measurement is crucial prior to clinical studies evaluating IA pulsatility in relation to IA rupture risk. Prerequisite is a reliable and robust imaging method with high spatial and temporal resolution and standardization of the image analysis methods.

What Are the Useful Tips for Opening the Sylvian and Interhemispheric Fissures with Minimal Blood Loss

The transsylvian approach(TSA)and interhemispheric approach(IHA)are two basic and important surgical approaches for the treatment of cerebral aneurysms. The TSA is usually the first choice for treating middle cerebral artery aneurysms but is sometimes used for treating even anterior communicating artery, internal carotid artery, and basilar artery aneurysms. In contrast, the IHA is usually the first choice for treating anterior communicating artery and distal anterior cerebral artery aneurysms. Young inexperienced neurosurgeons may find these approaches difficult to perform without blood loss. Therefore, the aim of this study was to provide useful tips regarding hemostasis, brain retraction, and intraoperative microscope magnification for performing the TSA and IHA without blood loss by using intraoperative photography.

Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

A Case of Two Times Parturition by Caesarean Section after Stent-assisted Coil Embolization for the Ruptured Basilar Trunk Artery Aneurysm

A Case of Two Times Parturition by Caesarean Section after Stent-assisted Coil Embolization for the Ruptured Basilar Trunk Artery Aneurysm

Pathogenesis, Diagnosis and Treatment of the Cerebral Aneurysm

An intracranial aneurysm, also known as a brain aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. Aneurysms in the posterior circulation (basilar artery, vertebral arteries and posterior communicating artery) have a higher risk of rupture. Basilar artery aneurysms represent only 3–5% of all intracranial aneurysms but are the most common aneurysms in the posterior circulation.

Coexistence of posterior cerebral circulation anatomical variations and basilar artery aneurysms: Case-control study.

B a c k g r o u n d: The anatomy of arteries supplying blood to the brain often varies among the population. It applies particularly to posterior cerebral circulation. The impact of its anatomy variabilities on the formation of intracranial aneurysms has not been determined yet. The aim was to find out if posterior cerebral circulation anatomy variations coexist with basilar artery aneurysms (BAAs). We retrospectively analyzed 27 patients with BAA and a group of 30 patients matched by gender and age but without BAA. In both groups together most (66.67%) of patients were female and the average age was 59.75 ± 10.91. All of the patients had Computed Tomography performed. We assessed the occurrence of BAA, basilar artery (BA) diameter, vertebral artery (VA) diameter, posterior cerebral artery (PCA) diameter, and if patients had hypoplastic VA or PCA. Results: The presence of right VA hypoplasia significantly increased the risk of BAA occurrence (48.15% vs. 16.67%; p = 0.011). The occurrence of hypoplastic VA on either side was significantly associated with the risk of BAA formation (59.26% vs. 26.67%; p = 0.013). Patients with BAA had slightly larger left PCA diameter 1cm after division (1.96 ± 0.51 vs. 1.64 ± 0.42; p = 0.014) in comparison to those without BAA. Additionally, hypoplastic right PCA occurred more often in patients with BAA (22.22% vs. 0%; p = 0.022). Conclusions: We can conclude that the anatomy of PCA and VA affects the occurrence of BAA. Hypoplastic VA, the presence of wider left PCA and hypoplastic right PCA may be factors that coexist with BAA occurrence.

Is Flow Diversion the Death of Simple Coiling or Stent-assisted Coiling? A Single-center Experience.

Since the introduction of endovascular methods to treat cerebral aneurysms, several technical advances have allowed a greater number of aneurysms to be treated endovascularly as opposed to open surgical clipping. These include flow diverting stents, which do not utilize coils and instead treat aneurysms by acting as an "internal bypass." We sought to investigate whether flow diversion is replacing coiling at our institution. A retrospective chart review on five years of data was conducted to investigate the possible increasing use of flow diversion devices compared to traditional simple or stent-assisted coiling. Over five years, the population revealed a trend toward an increased proportion of female patients, increased frequency of basilar tip and internal carotid artery (ICA) aneurysm location, increased hospital volume, and increased volume of patients treated by dual-trained neurosurgeons over interventional radiologists. Patients were stratified by aneurysm location and statistically significant differences were observed. Flow diversion devices were used with increasing frequency when treating aneurysms arising from the proximal internal carotid artery (Odds ratio (OR)=1.24, 95% CI: 1.02-1.50; p = 0.03), and middle cerebral artery (OR=2.60, 95% CI: 1.38-4.88; p = 0.003). Distal internal carotid artery aneurysm location came close to achieving statistical significance (OR=1.3, 95% CI: 0.99-1.72; p = 0.063). In our single center experience at Houston Methodist Hospital, flow diversion devices are being used more frequently for aneurysms arising from the proximal ICA, MCA, and likely distal ICA (though this third location barely failed to achieve statistical significance.

Bilateral Transradial Approach for Coil Embolization of Basilar Artery Aneurysms Associated with an Unfavorable Vertebral Artery Anatomy

Bilateral Transradial Approach for Coil Embolization of Basilar Artery Aneurysms Associated with an Unfavorable Vertebral Artery Anatomy

Exosomal microRNA-23b-3p from bone marrow mesenchymal stem cells maintains T helper/Treg balance by downregulating the PI3k/Akt/NF-κB signaling pathway in intracranial aneurysm

Bone marrow mesenchymal stem cells (BMSCs) are involved in cancer initiation and metastasis, and sometimes mediate cell communication by releasing exosomes and delivering microRNAs (miRNAs). The study aims to investigate the effects of exosomal hsa-miR-23b-3p derived from human BMSCs on intracranial aneurysm (IA). Firstly, human BMSCs-derived exosomes were extracted by ultra-high speed centrifugation. After clinical specimen collection, imbalance of T helper (Th) 17/Treg was found in patients with IA. Then, basilar artery aneurysm models were established and BMSCs-derived exosomes were isolated and identified. The results showed that BMSCs-derived exosomes improved pathological remodeling of IA wall, upregulated the contractile phenotype and inhibited the secretory phenotype of smooth muscle cells and reduced the number of Th17 cells to maintain the balance of Th17/Treg. In addition, human BMSCs-derived exosomes inhibited the activation of the phosphatidylinositol-3 kinase (PI3K)/protein kinase B (Akt)/nuclear factor-kappa B (NF-κB) signaling pathway and maintained Th17/Treg balance, which in turn interfered with aneurysm formation. Finally, the targeting relationship between hsa-miR-23b-3p and KLF5 was confirmed. We further noted that BMSCs-derived exosomal hsa-miR-23b-3p inhibited IA formation by targeting KLF5 through suppression of the PI3k/Akt/NF-κB signaling pathway. All in all, our study concluded that BMSCs-derived exosomal hsa-miR-23b-3p could maintain Th17/Treg balance by targeting KLF5 through suppression of the PI3k/Akt/NF-κB signaling pathway, thus inhibit IA formation.

Long-Term Outcome of Endovascular Therapy for Large or Giant Thrombosed Intracranial Aneurysms

Large or giant thrombosed intracranial aneurysms (LGTIAs) are highly associated with poor prognosis and remain a challenging disease to treat by either surgery or endovascular treatment (EVT). EVT is considered more difficult for complicated aneurysm like LGTIAs. To understand long-term clinical and angiographic outcomes of EVT for LGTIAs, we retrospectively analyzed our single-center data on multimodality EVT for patients with LGTIAs. From the data of 35 EVT procedures performed in 31 consecutive patients with LGTIAs at our institution between December 2004 and December 2018, the rate of periprocedural complications, clinical outcomes at 12 months after EVT, and the rate of aneurysm recurrence were analyzed, and their related factors were evaluated. Initial EVTs were performed by deconstructive (n= 10) or reconstructive (n= 21) techniques. Although 5 patients (16%) died during the periprocedural period, 23 (74%) had good outcome at 12 months after the procedures. Among 26 patients with long-term follow-up, aneurysm recurrence was observed in 6 patients (23.1%; median time from treatment, 33.2 months). Aneurysm recurrence was significantly higher in patients with basilar artery aneurysm (P= 0.0421) and stroke (P= 0.0307); however, there was no significant difference between the procedures and devices used. Multimodality EVT for LGTIAs was performed with similar clinical outcomes and better radiologic outcomes compared with previous reports. New innovative techniques and devices are expected to be helpful for long-term aneurysm occlusion.

Clipping of Basilar and Middle Cerebral Artery Aneurysms: 2-dimensional operative video.

Careful preoperative planning for patients with multiple intracranial aneurysms is paramount given the importance of an appropriate trajectory and exposure for each aneurysm that will be clipped. The general principle is to clip aneurysms in a retrograde manner, such that more distal aneurysms are clipped earlier, and more superficial aneurysms are clipped later. This patient had unruptured middle cerebral artery (MCA) and basilar artery (BA) apex aneurysms and elected for surgical clipping of both lesions. An orbitozygomatic craniotomy ipsilateral to the MCA aneurysm was performed to permit clipping of both lesions. The dissection initially focused on exposure of the MCA aneurysm and then focused on the carotid-oculomotor triangle to permit basilar apex exposure and aneurysm clipping. The MCA aneurysm was clipped second. Postoperative imaging demonstrated complete obliteration of both aneurysms. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers.

The pretemporal transcavernous approach (PTA) provides optimal exposure and access to the basilar artery (BA); however, the PTA can be invasive when vital neurovascular structures are mobilized. The goal of this study was to evaluate mobilization strategies to tailor approaches to the BA. After an orbitozygomatic craniotomy, 10 sides of 5 cadaveric heads were used to assess the surgical access to the BA via the opticocarotid triangle (OCT), carotid-oculomotor triangle (COT), and oculomotor-tentorial triangle (OTT). Measurements were obtained, and morphometric analyses were performed for natural neurovascular positions and after each stepwise expansion maneuver. An imaginary line connecting the midpoints of the limbus sphenoidale and dorsum sellae was used as a reference to normalize the measurements of BA exposure and to facilitate the clinical applicability of this technique. In the OCT, the exposed BA segment ranged from - 1 ± 3.9 to + 6 ± 2.0mm in length in its natural position. In the COT, the accessible BA segment ranged from - 4 ± 2.3 to - 2 ± 3.0mm in length in its natural position. Via the OTT, the accessible BA segment ranged from - 7 ± 2.6 to - 5 ± 2.8mm in length in its natural position. In the OCT, COT, and OTT, a posterior clinoidectomy extended the exposure down to - 6 ± 2.7, - 8 ± 2.5, and - 9± 2.9mm, respectively. This study quantitatively evaluated the need for the expansion maneuvers in the PTA to reach BA aneurysms according to the patient's anatomical characteristics.

Clinical features and prognostic analysis of moyamoya disease associated with intracranial aneurysms

ABSTRACT Objectives To explore clinical features and compare of the difference between conservative treatment and surgical treatmentin prognosis of intracranial aneurysms associated with moyamoya disease (MMD). Methods 104 patients with MMD a ssociated with intracranial aneurysms diagnosed by digital subtraction angiography (DSA) or computed tomography angiography (CTA) were retrospectively analyzed. Results All patients of MMD with intracranial aneurysms had 129 aneurysms distributed at different sites. The distribution of the aneurysms was as follows: 28(21.71%) anterior communicating artery aneurysms, 21(16.28%) basilar artery aneurysms, 19(14.73%) middle cerebral artery aneurysms, 17(13.18%) posterior cerebral artery aneurysms, 12(9.30%)internal carotid artery aneurysms, 11(8.53%) posterior communicating artery aneurysms, 10(7.75%) anterior cerebral artery aneurysms, 5(3.88%) anterior choroidal artery aneurysms, 2(1.55%) moyamoya vessel aneurysms, and 4(3.1%) other location aneurysms. 82 cases (78.85%) had one aneurysm, and 21 cases (20.19%) had 2 or more aneurysms. 64 cases were treated surgically, and 40 cases were treated conservatively. 57 of 81 cases (70.37%) had a good outcome, 2 cases (2.47%) were in paralyzed, and 22 cases were died. The mortality rate was (27.16%). Death occurred in 16 (47.06%) of 34 patients with conservative treatment, and 6(12.77%) of 47 patients with surgical treatment. 7 cases (8.64%) had twice cerebral hemorrhage, and one case (1.23%) had third cerebral hemorrhage in the follow-up period. There were 5 deaths, two good outcomes, and one coma among 8 cases experienced re-hemorrhage. Conclusion Compared with conservative treatment, positive surgical treatment showed clinical significance for preventing cerebral hemorrhage and reducing mortality of MMD with intracranial aneurysms. Abbreviations MMD: moyamoya disease; DSA: digital subtraction angiography; CTA: computed tomography angiography