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Incidental major artery aneurysms in patients with non-hemorrhagic moyamoya disease

  • Clinical Article
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Abstract

Background

Major artery aneurysms may be found incidentally while evaluating moyamoya disease (MMD). The purpose of this study was to delineate the prevalence and characteristics of these uncommon aneurysms with a brief mention of their management and outcomes.

Methods

We conducted a retrospective review of 249 adult patients who were diagnosed with non-hemorrhagic MMD. Cerebral angiograms obtained at the time of initial diagnosis were carefully reviewed to identify incidental aneurysms located on a major intracranial artery or near its tributaries. Aneurysms originating from distal peripheral arteries or moyamoya vessels were ineligible for this study.

Results

Nine patients (3.6%) were found to have 13 major artery aneurysms, 7 (54%) of which were located in the posterior circulation, especially in older patients with bilateral MMD. The sizes of all aneurysms were less than 10 mm. Surgical clipping was performed on two aneurysms, and endovascular coiling on six (five posterior circulation aneurysms). Ischemic complications occurred in two patients after clipping of an anterior communicating artery aneurysm and in one patient after the second coiling of a recanalized basilar tip aneurysm.

Conclusions

Incidental major artery aneurysms can be found in 3.6% of adult patients with non-hemorrhagic MMD, an observed frequency that increases with age. About half of these aneurysms are located in the posterior circulation, particularly in older patients with bilateral MMD. Considering the risks of treatment-related complications, more information about the natural course of these aneurysms is needed to design proper management strategies both for the aneurysms and MMD.

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References

  1. Adams HP Jr, Kassell NF, Wisoff HS, Drake CG (1979) Intracranial saccular aneurysm and moyamoya disease. Stroke 10:174–179

    PubMed  Google Scholar 

  2. Ali MJ, Bendok BR, Getch CC, Gottardi-Littell NR, Mindea S, Batjer HH (2004) Surgical management of a ruptured posterior choroidal intraventricular aneurysm associated with moyamoya disease using frameless stereotaxy: case report and review of the literature. Neurosurgery 54:1019–1024, discussion 1024

    Article  PubMed  Google Scholar 

  3. Aoki N, Mizutani H (1984) Does moyamoya disease cause subarachnoid hemorrhage? Review of 54 cases with intracranial hemorrhage confirmed by computerized tomography. J Neurosurg 60:348–353

    Article  PubMed  CAS  Google Scholar 

  4. Arita K, Kurisu K, Ohba S, Shibukawa M, Kiura H, Sakamoto S, Uozumi T, Nakahara T (2003) Endovascular treatment of basilar tip aneurysms associated with moyamoya disease. Neuroradiology 45:441–444

    Article  PubMed  CAS  Google Scholar 

  5. Asari S (1992) Surgical management of the unruptured cerebral aneurysm accompanied by ischemic cerebrovascular disease. Clin Neurol Neurosurg 94:119–125

    Article  PubMed  CAS  Google Scholar 

  6. Borota L, Marinkovic S, Bajic R, Kovacevic M (1996) Intracranial aneurysms associated with moyamoya disease. Neurol Med Chir Tokyo 36:860–864

    Article  PubMed  CAS  Google Scholar 

  7. Fukui M (1997) Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis ('moyamoya' disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Clin Neurol Neurosurg 99 Suppl(2):S238–S240

    Google Scholar 

  8. Heman LM, Jongen LM, van der Worp HB, Rinkel GJ, Hendrikse J (2009) Incidental intracranial aneurysms in patients with internal carotid artery stenosis: a CT angiography study and a metaanalysis. Stroke 40:1341–1346

    Article  PubMed  Google Scholar 

  9. Hirotsune N, Meguro T, Kawada S, Nakashima H, Ohmoto T (1997) Long-term follow-up study of patients with unilateral moyamoya disease. Clin Neurol Neurosurg 99(Suppl 2):S178–S181

    PubMed  Google Scholar 

  10. Hyun SJ, Kim JS, Hong SC (2010) Prognostic factors associated with perioperative ischemic complications in adult-onset moyamoya disease. Acta Neurochir (Wien) 152:1181–1188

    Article  Google Scholar 

  11. Iwama T, Hashimoto N, Tsukahara T, Murai B (1995) Peri-operative complications in adult moyamoya disease. Acta Neurochir (Wien) 132:26–31

    Article  CAS  Google Scholar 

  12. Iwama T, Todaka T, Hashimoto N (1997) Direct surgery for major artery aneurysm associated with moyamoya disease. Clin Neurol Neurosurg 99(Suppl 2):S191–S193

    PubMed  Google Scholar 

  13. Kawaguchi S, Sakaki T, Kakizaki T, Kamada K, Shimomura T, Iwanaga H (1996) Clinical features of the haemorrhage type moyamoya disease based on 31 cases. Acta Neurochir (Wien) 138:1200–1210

    Article  CAS  Google Scholar 

  14. Kawaguchi S, Sakaki T, Morimoto T, Kakizaki T, Kamada K (1996) Characteristics of intracranial aneurysms associated with moyamoya disease. A review of 111 cases. Acta Neurochir (Wien) 138:1287–1294

    Article  CAS  Google Scholar 

  15. Kawano T, Fukui M, Hashimoto N, Yonekawa Y (1994) Follow-up study of patients with "unilateral" moyamoya disease. Neurol Med Chir Tokyo 34:744–747

    Article  PubMed  CAS  Google Scholar 

  16. Kelly ME, Bell-Stephens TE, Marks MP, Do HM, Steinberg GK (2006) Progression of unilateral moyamoya disease: a clinical series. Cerebrovasc Dis 22:109–115

    Article  PubMed  Google Scholar 

  17. Kim JE, Lim DJ, Hong CK, Joo SP, Yoon SM, Kim BT (2010) Treatment of unruptured intracranial aneurysms in South Korea in 2006: a nationwide multicenter survey from the Korean society of cerebrovascular surgery. J Korean Neurosurg Soc 47:112–118

    Article  PubMed  Google Scholar 

  18. Kim SH, Choi JU, Yang KH, Kim TG, Kim DS (2005) Risk factors for postoperative ischemic complications in patients with moyamoya disease. J Neurosurg 103:433–438

    PubMed  Google Scholar 

  19. Kim SH, Kwon OK, Jung CK, Kang HS, Oh CW, Han MH, Kim YS, Baik SK (2009) Endovascular treatment of ruptured aneurysms or pseudoaneurysms on the collateral vessels in patients with moyamoya disease. Neurosurgery 65:1000–1004, discussion 1004

    Article  PubMed  Google Scholar 

  20. Kodama N, Sato M, Sasaki T (1996) Treatment of ruptured cerebral aneurysm in moyamoya disease. Surg Neurol 46:62–66

    Article  PubMed  CAS  Google Scholar 

  21. Kodama N, Suzuki J (1978) Moyamoya disease associated with aneurysm. J Neurosurg 48:565–569

    Article  PubMed  CAS  Google Scholar 

  22. Kuroda S, Houkin K, Kamiyama H, Abe H (2001) Effects of surgical revascularization on peripheral artery aneurysms in moyamoya disease: report of three cases. Neurosurgery 49:463–467, discussion 467-468

    PubMed  CAS  Google Scholar 

  23. Marushima A, Yanaka K, Matsuki T, Kojima H, Nose T (2006) Subarachnoid hemorrhage not due to ruptured aneurysm in moyamoya disease. J Clin Neurosci 13:146–149

    Article  PubMed  Google Scholar 

  24. Massoud TF, Guglielmi G, Vinuela F, Duckwiler GR (1994) Saccular aneurysms in moyamoya disease: endovascular treatment using electrically detachable coils. Surg Neurol 41:462–467

    Article  PubMed  CAS  Google Scholar 

  25. Nagamine Y, Takahashi S, Sonobe M (1981) Multiple intracranial aneurysms associated with moyamoya disease. Case report. J Neurosurg 54:673–676

    Article  PubMed  CAS  Google Scholar 

  26. Nagashima M, Nemoto M, Hadeishi H, Suzuki A, Yasui N (1993) Unruptured aneurysms associated with ischaemic cerebrovascular diseases. Surgical indication. Acta Neurochir (Wien) 124:71–78

    Article  CAS  Google Scholar 

  27. Oh YS, Lee SJ, Shon YM, Yang DW, Kim BS, Cho AH (2008) Incidental unruptured intracranial aneurysms in patients with acute ischemic stroke. Cerebrovasc Dis 26:650–653

    Article  PubMed  Google Scholar 

  28. Osanai T, Kuroda S, Nakayama N, Yamauchi T, Houkin K, Iwasaki Y (2008) Moyamoya disease presenting with subarachnoid hemorrhage localized over the frontal cortex: case report. Surg Neurol 69:197–200

    Article  PubMed  Google Scholar 

  29. Pandey AS, Koebbe C, Rosenwasser RH, Veznedaroglu E (2007) Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery 60:626–636, discussion 636-637

    Article  PubMed  Google Scholar 

  30. Peltier J, Vinchon M, Soto-Ares G, Dhellemmes P (2008) Disappearance of a middle cerebral artery aneurysm associated with moyamoya syndrome after revascularization in a child: case report. Childs Nerv Syst 24:1483–1487

    Article  PubMed  Google Scholar 

  31. Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256

    PubMed  CAS  Google Scholar 

  32. Satoh T, Yamamoto Y, Asari S, Sakurai M, Suzuki K (1983) Disappearance and development of cerebral aneurysms in moyamoya disease. Case report. J Neurosurg 58:949–953

    Article  PubMed  CAS  Google Scholar 

  33. Suzuki J, Kodama N (1983) Moyamoya disease–a review. Stroke 14:104–109

    PubMed  CAS  Google Scholar 

  34. Suzuki J, Takaku A (1969) Cerebrovascular "moyamoya" disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288–299

    PubMed  CAS  Google Scholar 

  35. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828

    Article  PubMed  CAS  Google Scholar 

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No other persons have made substantial contributions.

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No funds were received in support of this work.

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Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 IL-Won Dong, Kang-Nam Ku, Seoul, Republic of Korea, 135-710

    Je Young Yeon, Jong-Soo Kim & Seung-Chyul Hong

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  1. Je Young Yeon
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  2. Jong-Soo Kim
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  3. Seung-Chyul Hong
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Correspondence to Seung-Chyul Hong.

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Yeon, J.Y., Kim, JS. & Hong, SC. Incidental major artery aneurysms in patients with non-hemorrhagic moyamoya disease. Acta Neurochir 153, 1263–1270 (2011). https://doi.org/10.1007/s00701-011-0948-y

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  • DOI: https://doi.org/10.1007/s00701-011-0948-y

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