Treatment strategies for aneurysms associated with moyamoya disease

Abstract

The treatment of aneurysms associated with moyamoya disease (MMD) is difficult for neurosurgeons, and little is known of strategy options. This report constitutes a comprehensive review of the literature. We summarize the known treatments and their clinical outcomes according to the site of the aneurysm: in major arteries, peripheral arteries, moyamoya vessels, meningeal arteries, or at the site of anastomosis. The literature review indicates that the treatment of MMD-associated aneurysms varies according to the site of the aneurysm and its hemodynamic characteristics. In particular, the treatment for basilar tip aneurysms remains challenging, since both endovascular embolization and direct clipping are difficult. The potential risk for ischemia should be considered in selecting endovascular or surgical approaches. Revascularization surgery, which is important for the treatment of MMD, also determines the clinical treatment outcome of aneurysms associated with MMD.

Keywords: Moyamoya disease; aneurysms; treatment.

Figure 1

Schematic of intracranial aneurysms associated with MMD, categorized into five subgroups, according to their anatomic location: major arteries (e.g., anterior and posterior circulation); peripheral arteries (AChA and PChA); Moyamoya vessels (LSA and TPA); meningeal arteries; and at the site of anastomosis.