Endovascular treatment of intracranial aneurysms associated with moyamoya disease or moyamoya syndrome

Abstract

Direct surgical clipping proves to be difficult and dangerous for intracranial aneurysms associated with moyamoya disease (MMD) or moyamoya syndrome (MMS). This study presents our clinical experience of endovascular embolization of intracranial aneurysms associated with these diseases. A total of 13 cases of intracranial aneurysms associated with MMD or MMS were treated by endovascular embolization between January 2001 and January 2009. Patients were divided into two groups: a saccular aneurysm group (n=10) and a pseudoaneurysm group (n=3). Different endovascular therapeutic strategies were employed for each type of case. Of the 13 cases, 11 received successful endovascular embolization and had an uneventful postoperative course during one to two years of follow-up. However, endovascular embolization failed in the other two cases, of whom one died from rebleeding after the five-month follow-up, while the other was conservatively treated and experienced no rebleeding during the two-year follow-up. A favorable prognosis may be secured through careful selection of endovascular treatment regimens for patients with intracranial aneurysms associated with MMD or MMS according to the site of intracranial aneurysms.

Figure 1

Radiological imaging of MMS associated with the anterior communicating artery aneurysm in the saccular group (case 1). A) CT shows SAH. B) CTA shows an anterior communicating artery aneurysm and right MMS. C,D) DSA shows an anterior communicating artery aneurysm and right-side MMS. E) 3D-DSA provides an optimal view of aneurysm embolization. F) DSA shows a well-developed left carotid artery (arrow). G) Repeated DSA shows no recurrence of aneurysm (arrow).

Figure 2

Radiological imaging of MMD associated with basilar tip aneurysm in the saccular aneurysm group (case 7). A) SAH is shown. B) CTA shows MMD and basilar tip aneurysm. C,D) DSA shows the aneurysm (arrow) and extended blood supply from posterior circulation (ellipse). E) DSA shows basilar tip aneurysm (arrow). E) aneurysm embolization is shown. F) Repeated CT scan six months after surgery reveals radial artifacts. G) Repeated DSA shows no recurrence of aneurysm.

Figure 3

Radiological imaging of MMD associated with left anterior choroidal artery aneurysm in the pseudoaneurysm group (case 1). A) CT shows IVH. B-D) DSA shows a anterior choroidal artery aneurysm and MMD. E) Microcatheter superselective angiography. F,G) DSA shows the parent artery and the embolized aneurysm. H-I) Repeated DSA shows no recurrence of aneurysm.

Figure 4

A case in the saccular aneurysm group who died after receiving unsuccessful endovascular embolization (case 9). A) CT shows SAH in the interpeduncular cistern. B) CTA shows pontine aneurysm of the basilar artery. C-F) DSA shows MMD and pontine aneurysm of the basilar artery. G) The patient died of aneurysm rupture and rebleeding five months after surgery.

Figure 5

A case in the pseudoaneurysm group with favorable prognosis after unsuccessful endovascular embolization (case 3). A) CT shows basal ganglia hemorrhage. B-D) Bilateral carotid artery angiography shows MMD and pseudoaneurysm (arrow). E) Repeated CT shows hematoma being absorbed one week after attempted embolization. F) DSA shows that the aneurysm disappeared one week after surgery.