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Updated: May 5, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Radiological Features and Management of Intracranial Aneurysms Associated With Moyamoya Disease: A Case Series of
Subash Phuyal1, Shailesh B Gaikwad2, Ajay Garg2
1Neuroimaging and Interventional Neuroradiology, Upendra Devkota Memorial (UDM) National Institute of Neurological and Allied Sciences, Kathmandu, NPL.
Abstract:
Background Moyamoya disease (MMD) can be a major cause of hemorrhagic stroke. Though extensive angiographic studies have been undertaken, the understanding of the association between aneurysms and MMD remains unanswered. In this study, we explore the association of the aneurysm with MMD and its management. We have also reviewed such associations described in the literature and how the present cases differ from those previously described. Materials and methods The clinical and radiologic data of moyamoya disease cases were accessed from medical and radiological records between January 2010 and July 2017. Two neuroradiologists independently analyzed the data and imaging details. Results Out of 103 patients with MMD, eight patients (7.77%) had associated intracranial aneurysms with eleven aneurysms. Out of the 11 aneurysms, five were the tip of the basilar artery aneurysms and were the most common location for aneurysm (45.5%), followed by lenticulostriate artery, PCA perforator, and distal ACA (DACA) in the P1 PCA, P2 PCA, and P3 PCA artery aneurysms. Out of eight patients, five (62.5%) had a hemorrhage on a non-contrast computed tomography (NCCT) scan of the brain, whereas three (37.5%) had an ischemic presentation. Out of 11 aneurysms, seven aneurysms, including three basilar tip aneurysms (unruptured) and one PCA perforator (ruptured), and three saccular PCA (P1, P2, and P3) (ruptured) were treated by endovascular coiling. Follow-up angiography showed stable aneurysmal occlusion except in one basilar tip, where recurrence was observed. Conclusions MMD-intracranial aneurysm is commonly observed in patients with intracranial hemorrhage and carries a higher risk of rupture. Therefore, identification of the aneurysm is essential for management. Endovascular treatment, either with coil or glue embolization, can be a safe and effective treatment method for such aneurysms with long-term good results.
Insights
Moyamoya disease (MMD) is linked to intracranial aneurysms, often causing hemorrhage. Early detection and endovascular treatment are key for managing these MMD-associated aneurysms and improving outcomes.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Moyamoya disease (MMD) is a significant cause of hemorrhagic stroke.
- The association between aneurysms and MMD requires further investigation.
- Understanding this relationship is crucial for effective patient management.
Purpose of the Study:
- To explore the association between Moyamoya disease and intracranial aneurysms.
- To analyze the management strategies for MMD-associated aneurysms.
- To compare current findings with existing literature.
Main Methods:
- Retrospective analysis of clinical and radiological data from 103 MMD patients (2010-2017).
- Independent review of data and imaging by two neuroradiologists.
- Literature review of MMD-aneurysm associations.
Main Results:
- Eight MMD patients (7.77%) presented with 11 intracranial aneurysms.
- Basilar tip aneurysms were most common (45.5%), followed by PCA and ACA.
- Hemorrhagic presentation occurred in 62.5% of patients; endovascular coiling was successful in 7/11 aneurysms.
Conclusions:
- MMD-associated intracranial aneurysms are frequently observed in patients with intracranial hemorrhage.
- These aneurysms carry a high risk of rupture, necessitating prompt identification.
- Endovascular treatment offers a safe and effective management option with good long-term results.
