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Updated: May 5, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Five aneurysms in the posterior circulation associated with moyamoya disease: illustrative case
Yao Anhui1,2, Liyun Jia3, Wei Huang1
1Department of Neurosurgery, The 988th Hospital of PLA, Zhengzhou, Henan Province, China.
Background:
The prevalence of aneurysm formation in adults with moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient's disease characteristics.
Observations:
The authors report the case of a man who presented with an intraparenchymal hemorrhage. Cerebral angiography showed a typical MMD pattern characterized by occlusion and severe stenosis at the terminal portions of the bilateral internal carotid arteries, accompanied by moyamoya-like vasodilation. The bilateral posterior cerebral arteries (PCAs) had collateral blood supply to the anterior circulation, and 5 aneurysms were observed, which is rare. Considering that revascularization through bypass surgery could alter the hemodynamic stresses associated with MMD, the authors performed bilateral extracranial-intracranial bypass surgeries to reconstruct the anterior circulation and reduce the blood flow burden on the vertebrobasilar system. Follow-up imaging demonstrated improved cerebral perfusion in both hemispheres. Importantly, 3 of the 5 aneurysms remained stable, 1 aneurysm had shrunk, and the other had completely resolved.
Lessons:
For stable patients with cerebral hemorrhage, CT angiography is recommended before treatment. In surgery of patients with MMD-associated hemorrhage, avoid using artificial dura mater as it can hinder external carotid circulation and complicate future bypass procedures. https://thejns.org/doi/10.3171/CASE24848.
Insights
Moyamoya disease (MMD) patients with aneurysms who experience hemorrhage may benefit from bypass surgery. This intervention improved cerebral perfusion and led to aneurysm shrinkage or resolution in a rare case.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Moyamoya disease (MMD) presents a higher risk of aneurysm formation in adults compared to the general population.
- Treatment for MMD-associated aneurysms is highly individualized, depending on specific patient and disease characteristics.
Purpose of the Study:
- To present a rare case of moyamoya disease with multiple aneurysms and intraparenchymal hemorrhage.
- To evaluate the efficacy of bilateral extracranial-intracranial bypass surgery in managing MMD-associated hemorrhage and aneurysms.
Main Methods:
- A patient with intraparenchymal hemorrhage underwent cerebral angiography, revealing typical MMD features and five aneurysms.
- Bilateral extracranial-intracranial bypass surgeries were performed to reconstruct anterior circulation and alleviate pressure on the vertebrobasilar system.
Main Results:
- Post-surgery imaging showed improved cerebral perfusion in both hemispheres.
- Of the five observed aneurysms, three remained stable, one decreased in size, and one completely resolved.
Conclusions:
- CT angiography is recommended for stable patients with cerebral hemorrhage prior to treatment.
- Avoiding artificial dura mater during surgery for MMD-associated hemorrhage is crucial to prevent complications with external carotid circulation and future bypass procedures.
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