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Managing intervention for severe intraventricular hemorrhage casting in moyamoya disease: Report of two cases

Yukihiro Goto1, Hideki Oka1, Akihiko Hino1

  • 1Department of Neurosurgery, Saiseikai Shiga Hospital, 2-4-1, Ohashi, Ritto-City, Shiga-Prefecture, 520-3046, Japan.

International Journal of Surgery Case Reports
|July 30, 2020
PubMed
Abstract

Insights

Early surgical intervention for severe intraventricular hemorrhage (IVH) in moyamoya disease (MMD) can lead to good outcomes. This approach challenges the traditional non-intervention strategy in the acute phase, offering a potential alternative for MMD patients.

Area of Science:

  • Neurosurgery
  • Vascular Neurology

Background:

  • Moyamoya disease (MMD) with severe intraventricular hemorrhage (IVH) typically follows a conservative management approach in the acute phase.
  • The empirical rule of not evacuating IVH in MMD has not been supported by scientific data, despite associated devastating outcomes.

Observation:

  • Two cases of MMD with severe IVH and ruptured aneurysms are presented.
  • Both patients presented with a low Glasgow Coma Scale (GCS) score of 4 and significant IVH on CT scans.
  • Treatment involved obliteration of the ruptured aneurysm followed by early endoscopic aspiration of IVH.

Findings:

  • Case 1: A 55-year-old female achieved a modified Rankin Scale (mRS) of 1 post-procedure.
  • Case 2: A 44-year-old female achieved an mRS of 2 post-procedure.
  • Both patients demonstrated favorable outcomes following early IVH aspiration.

Implications:

  • Early surgical removal of severe IVH casting is a viable approach for MMD patients.
  • This strategy may prevent poor outcomes in MMD patients experiencing critical intracranial pressure due to severe IVH.
  • Challenging established empirical rules with evidence-based interventions can improve patient management.
Keywords:
Endoscopic surgeryIntraventricular aneurysmIntraventricular hemorrhageMoyamoya disease

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