Five Cases of Moyamoya Disease with Intracranial Aneurysms

Onda, Hideaki; Kagawa, Mizuo; Wanifuchi, Hiroshi; Aoki, Nobuo; Takeshita, Mikihiko; Ujiié, Hiroshi; Izawa, Masahiro; Kitamura, K

doi:10.2335/scs1987.16.2_168

Cited by 10 publications

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“…In our series, the incidence of aneurysms was 15%, and the mean age was 46 years. Our results are similar to those reported in the literature [1,[11][12][13]. A radical surgery for the aneurysms should be performed to prevent rerupture and enlargement of the ruptured aneurysms on the circle of Willis due to the haemodynamic stress [1,11,13].…”

Section: Discussionsupporting

confidence: 82%

Clinical features of the haemorrhage type moyamoya disease based on 31 cases

et al. 1996

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We evaluated and analysed our own 31 cases of the haemorrhagic type of moyamoya disease to clarify the clinical features of this disease. The cases were divided into three groups. Group A consisted of 12 cases with aneurysms. Aneurysms on the circle of Willis were treated as ordinary saccular aneurysms. Group B consisted of 14 cases with intracerebral haemorrhage (ICH) without aneurysms. These were managed almost as spontaneous ICH. Group C consisted of 5 cases with intraventricular haemorrhage (IVH) without aneurysms or ICH. Twenty-two surgical procedures for aneurysms, ICH and IVH were done in 19 cases (62%). Nineteen procedures for preventing future strokes were undertaken in 11 cases (35%). The overall initial outcome was excellent in 12 cases (39%), good in 7 cases (23%), poor in 7 cases (23%), and death in 5 cases (15%). During the follow-up period (mean: 6.5 years), rebleeding occurred in two cases (8%), and ischaemic attacks in two cases (8%). The rate of rebleeding or ischaemic attacks was 1.19% per patient-year during the follow-up period. There was no ischaemic or rebleeding episode in cases treated by STA-MCA bypass with encephalomyosynagiosis (EMS) during the follow-up period. Management of the primary haemorrhage should be according to the clinical condition, type of haemorrhage, and source of haemorrhage. When the patient needs to undergo revascularization surgery to prevent future strokes, we recommend STA-MCA bypass with EMS instead of encephaloduro-arteriosynangiosis (EDAS).

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Section: Discussionsupporting

confidence: 82%

Clinical features of the haemorrhage type moyamoya disease based on 31 cases

et al. 1996

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“…Of these fif- (1984) [13] 55/F 2 4 Hanakita et al Case 3 (1988) [8] 54/F 5 5 Kawaguchi et al Case 3 (1996) 48/M 4 6 Kawaguchi et al Case 7 (1996) 53/F 4 Case 1 (1983) [42] 16/F 4 14 Nomura et al (1983) [27] 35/M 4 15 Murakami et al (1984) [23] 33/F 4 t6 Sato et al Case 1 (1984) [34] 38/M 4 17 Konishi et al Case 3 (1985) [15] 57/F 4 18 Konishi et al Case 5 (1985) [15] 34/F 4 19 Konishi et at. (1985) [15] 48/1= 4 20 Ando et al, Case 6 (1988) [2] 59/F 3 21 Onda et al Case 2 (1988) [30] 43/1: 2 22 Massoud et al Case 2 (1994) [19] 34/M 0 [2,5,7,25,30]. Posterior circulation aneurysms associated with Moyamoya disease form and grow as a result of haemodynamic stress due to the obstruction of the internal carotid artery [41].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of intracranial aneurysms associated with moyamoya disease

et al. 1996

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A retrospective analysis of 111 patients with aneurysms associated with Moyamoya disease is presented. The subjects comprised of our 12 cases and 99 other well-documented cases. These 111 cases had 131 aneurysms. There were 48 males and 63 females. The average age was 40.3 years. The clinical manifestations were intracranial haemorrhage in 99 cases (89%), and ischaemic events in 9 cases (8%), but no mention was made of these in the last three cases (2%). The Hunt and Kosnik grades were grade 1 in 8%, grade 2 in 23%, grade 3 in 31%, grade 4 in 35%, and grade 5 in 3%. Of the 131 aneurysms, 73 (56%) were found distributed around the circle of Willis, 24 (18%) in the basal ganglia, 29 (22%) on collateral vessels, and 5 (4%) on other vessels. Forty-six percent of the cases were treated surgically, 51% conservatively, and 3% by endovascular procedures. The surgical procedures for the aneurysms were; neck clipping in 49%, aneurysmectomy in 18%, wrapping of the aneurysm in 11%, coating or cautery of the aneurysm in 7%, and revascularization only in 11%. The outcomes were Glasgow Outcome Scale 1 in 30%, 2 in 22%, 3 in 11%, 4 in 1%, and 5 in 25%. The main reasons for the unfavourable outcome were initial poor clinical grade and rebleeding. Follow-up angiography of 25 aneurysms demonstrated that all aneurysms in the basal ganglia or on the collateral vessels disappeared. We recommend surgical intervention for aneurysms associated with Moyamoya disease to prevent rupture or rebleeding, especially for aneurysms around the circle of Willis. However, direct surgery is not recommended for aneurysms found in the basal ganglia or on the collateral vessels.

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Ruptured Distal Anterior Choroidal Artery Aneurysm Presenting with Casting Intraventricular Haemorrhage

Yoneoka

Ezuka

Takai

et al. 1998

Acta Neurochirurgica

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This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricular haemorrhage and a small round low-dense lesion within the haematoma at the right trigone. The haematoma with obstructive hydrocephalus made the lateral ventricles larger on the right than on the left. CT scan could not detect any subarachnoid haemorrhage. Right interal carotid angiography revealed a saccular aneurysm at the plexal point of the right anterior choroidal artery. We approached the aneurysm and the small round lesion through the trigone via a right temporo-occipital corticotomy. We could clip the aneurysmal neck and remove the intraventricular haematoma and the papillary cystic mass (corresponding to the small round lesion on CT scan) totally in one sitting. Histological examination revealed the aneurysm to be a true one and the papillary cystic mass to be a choroid plexus cyst.

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Five Cases of Moyamoya Disease with Intracranial Aneurysms

Cited by 10 publications

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Clinical features of the haemorrhage type moyamoya disease based on 31 cases

Clinical features of the haemorrhage type moyamoya disease based on 31 cases

Characteristics of intracranial aneurysms associated with moyamoya disease

Ruptured Distal Anterior Choroidal Artery Aneurysm Presenting with Casting Intraventricular Haemorrhage

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