Intracranial saccular aneurysm and moyamoya disease.

Abstract

SUMMARY Moyamoya disease is a rare but well described entity which has been found in the angiographic investigation of subarachnoid hemorrhage, its most common symptom in adults. We present 4 patients in whom moyamoya disease and an intracranial saccular aneurysm were discovered. In 2 of the 3 patients suffering a hemorrhage, the aneurysm was the source of bleeding. Three of the aneurysms were located at the basilar artery bifurcation. We recommend a careful search for a concomitant aneurysm in all patients with subarachnoid hemorrhage in whom moyamoya disease is found. We believe these patients should be treated as though the aneurysm were the source of bleeding.

Understanding and treating moyamoya disease in children

“…In addition, typical saccular aneurysms, many of which are located in posterior circulation vessels (with the basilar tip being the most common), 58 are seen more frequently in adults with moyamoya than in the general population. 77 Saccular aneurysms 1 and pseudoaneurysms, which can develop along peripheral portions of perforating moyamoya vessels and the anterior and posterior choroidal arteries, 49,99 also represent potential sources of hemorrhage. The incidence of aneurysms in children with moyamoya disease is ~ 1%, whereas that in adults is ~ 6.2%.…”

Combined extracranial-intracranial bypass surgery with stent-assisted coil embolization for moyamoya disease with a ruptured wide-necked basilar trunk aneurysm:a case report

“…cerebral revascularization had never been used alone before (1,6). However, treating aneurysms may only eradicate the direct cause of rebleeding but does not solve the fundamental problem of revascularizing ischemic hemispheres.…”

Intracranial Aneurysms Associated with Moyamoya Disease

“…These changes may result in localized dilatation of the parenchymal vessels, i. e. the abnormal net-like vessels (dilated and tortu ous perforating arteries), the medullary arteries, and the branches of the anterior choroidal and posterior choroidal arteries. 2,6,8,19,21) Pseudoaneurysms are most often located in the abnormal vascular net work, especially in the ganglionic and thalamic region (our Case 1), as well as in the periventricular Saccular aneurysms are most likely caused by hemodynamic stress due to increased blood flow and consequent turbulence in certain portions of the cerebrovascular system, especially in the posterior cir culation.1 '3,5,6,8,9) The development of aneurysms and/or elastic lamina destruction is especially likely in the presence of a media defect in the wall of the affected arteries.5,7) Saccular aneurysms are usually located on the main cerebral arteries and their lep tomeningeal or choroidal branches, and have been found on the following arteries in moyamoya dis ease patients: the ICA, i. e. the cavernous (C3) seg ment or the supraclinoid (C4) segment (the ophthal mic artery origin)," 1,14) the ACA (the A2 segment, the orbitofrontal or the pericallosal artery ori gin)4,21"; the anterior communicating artery 6,21) the MCA (M1 segment),8 the anterior choroidal artery (the origin or distal part),6°19) the PCoA (the ori gin) 1,11,14); the PCA (the P1 segment or distal seg ment)1'6); the lateral posterior choroidal artery6,12,19); the basilar artery (the distal part or the bifurcation site) ' 5,6,8,9,12) and the superior cerebellar artery (the origin) .5,6,9) Aneurysms in the moyamoya disease patients are most often located on the bifurcation site of the basilar artery and on the cavernous seg ment of the ICA.6°8°9) The vertebrobasilar system is involved more often in moyamoya disease patients (43%) than in the general population (5.3-9.6%).g) The MCA, ACA, and anterior communicating ar tery are very rarely involved.") One of our patients had a saccular aneurysm on the middle meningeal artery.…”