Treatment of aneurysms in patients with moyamoya disease: a 10-year single-center experience

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OBJECTIVE

Moyamoya disease (MMD) is occasionally accompanied by intracranial aneurysms. The purpose of this study was to delineate the efficacy of the authors’ current surgical strategy in the management of MMD-associated aneurysms of different types.

METHODS

Between January 2007 and March 2016, a consecutive cohort of 34 patients with 36 MMD-associated aneurysms was enrolled in this prospective single-center cohort study. The lesions were classified as peripheral (17 aneurysms) or main trunk aneurysms (13 in the anterior circulation and 6 in the posterior circulation). For the peripheral aneurysms, revascularization with or without endovascular treatment was suggested. For the main trunk aneurysms, revascularization alone, revascularization with aneurysm clipping, or revascularization with aneurysm embolization were used, depending on the location of the aneurysms.

RESULTS

Of the peripheral aneurysms, 4 were treated endovascularly with staged revascularization, and 13 were treated solely with cerebral revascularization. Of the 13 main trunk aneurysms in the anterior circulation, 10 were clipped followed by revascularization, and 3 were coiled followed by staged cerebral revascularization. Of the 6 main trunk aneurysms in the posterior circulation, 4 underwent endovascular coiling and 2 were treated solely with revascularization. One patient died of contralateral intracerebral hemorrhage 6 months after the operation. No other patients suffered recurrent intracranial hemorrhage, cerebral ischemia, or aneurysm rupture. An angiographic follow-up study showed that all the bypass grafts were patent. Complete occlusion was achieved in all 21 aneurysms that were clipped or embolized. Of the remaining 15 aneurysms that were not directly treated, 12 of 13 peripheral aneurysms were obliterated during the follow-up, whereas 1 remained stable; 1 of 2 posterior main trunk aneurysms remained stable, and the other became smaller.

CONCLUSIONS

The authors’ current treatment strategy may benefit patients with MMD-associated aneurysms.

ABBREVIATIONS ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACoA = anterior communicating artery; BA = basilar artery; DSA = digital subtraction angiography; ECA = external carotid artery; EDMS = encephaloduromyosynangiosis; ICA = internal carotid artery; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; LSA = lenticulostriate artery; MCA = middle cerebral artery; MMD = moyamoya disease; mRS = modified Rankin Scale; OphA = ophthalmic artery; PCA = posterior cerebral artery; PChA = posterior choroidal artery; SAH = subarachnoid hemorrhage; STA-MCA = superficial temporal artery–middle cerebral artery.

Article Information

Correspondence Yuxiang Gu, Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Rd., Shanghai 200040, P. R. China. email: guyuxiang1972@126.com.

INCLUDE WHEN CITING Published online August 25, 2017; DOI: 10.3171/2017.3.JNS162290.

Drs. Ni and Jiang contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Management algorithm for MMD-associated aneurysms.

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    Case 7. A: Axial CT scan revealing SAH in the longitudinal fissure, sylvian fissure, and quadrigeminal cistern. B and C: Bilateral ICA angiography studies showing MMD with Suzuki Stage III. D: Vertebral angiography study showing a saccular aneurysm at the P1/P2 junction of the right PCA. E and F: Follow-up vertebral angiography studies showing complete obliteration of the aneurysm. G and H: Follow-up external carotid artery (ECA) angiography studies showing Matsushima Grade A collateral compensation supplied by the anastomosis.

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    Case 14. A: Axial CT scan revealing bilateral IVH. B–D: Bilateral ICA angiography studies showing MMD with a peripheral aneurysm in the distal segment of the left AChA. E and F: Follow-up ICA angiography studies showing complete obliteration of the aneurysm by Onyx 18. G and H: Follow-up ECA angiography studies showing Matsushima Grade A collateral compensation supplied by the anastomosis.

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    Case 19. A: Axial CT scan revealing bilateral IVH. B and C: ICA angiography studies showing MMD with a peripheral aneurysm in the distal segment in the right AChA (arrows). D: Intraoperative photograph showing the anastomosis between the STA and the cortical branch of the MCA. E: A 3D CT angiography study showing the patency of the bypass. F and G: Follow-up ECA angiography studies showing Matsushima Grade A collateral compensation supplied by the anastomosis. H and I: Follow-up ICA angiography studies showing complete obliteration of the aneurysm. Figure is available in color online only.

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    Case 29. A: Axial CT scan revealing a right caudate hematoma with bilateral IVH. B–D: Bilateral ICA angiography studies showing MMD with peripheral aneurysm in 1 LSA originating from the right MCA (arrows). E: Intraoperative photograph showing the anastomosis between the STA and cortical branch of the MCA. F and G: Follow-up ECA angiography studies showing Matsushima Grade B collateral compensation supplied by the anastomosis. H and I: Follow-up ICA angiography studies showing complete obliteration of the aneurysm. Figure is available in color online only.

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