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J Neurosurg. 2018 Jun;128(6):1813-1822. doi: 10.3171/2017.3.JNS162290. Epub 2017 Aug 25.

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

Abstract

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.

KEYWORDS:

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; OphA = ophthalmic artery; PCA = posterior cerebral artery; PChA = posterior choroidal artery; SAH = subarachnoid hemorrhage; STA-MCA = superficial temporal artery–middle cerebral artery; aneurysm; mRS = modified Rankin Scale; moyamoya disease; revascularization; treatment strategy; vascular disorders

PMID:
28841118
DOI:
10.3171/2017.3.JNS162290

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