1/56. A case of moyamoya-like vessels combined with brain anomaly.We report here a rare case of moyamoya-like vessels combined with brain anomaly. MR imaging revealed a small corpus callosum and stenosis of the internal carotid arteries. T2-weighted images revealed multiple hyperintense lesions in the cerebral deep white matter, suggesting ischemic or abnormal myelinated tissues. cerebral angiography showed aplastic carotid siphons and anomalous aneurysmal dilatation of the petrous portion of the internal carotid arteries. The terminal portion of the internal carotid arteries and horizontal portion of the middle cerebral artery were stenotic with moyamoya-like vessels.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/56. Intraventricular aneurysms--three case reports.Three rare cases of purely intraventricular aneurysms are described, including a unique aneurysm in the fourth ventricle. A 30-year-old female, a 47-year-old male, and an 11-year-old girl presented with disturbance of consciousness due to massive intraventricular hemorrhage. Digital subtraction angiography revealed an idiopathic peripheral aneurysm in the fourth ventricle in the first patient, and aneurysms in the lateral ventricle associated with moyamoya disease in the latter two patients. The former two aneurysms were treated surgically and histologically confirmed to be pseudoaneurysms. The latter aneurysm disappeared spontaneously within 2 months after onset. The aneurysm in the lateral ventricle was resected via a parietal corticotomy with stereotactic insertion of an 8-Fr silicone tube to guide the approach route. This method was very useful because computerized neuronavigation was not available. The aneurysm in the fourth ventricle was resected via a midline suboccipital approach with C-1 laminectomy. Conservative treatment is usually recommended initially for patients with intraventricular aneurysm because spontaneous cure often occurs. We recommend direct surgery if the size of the aneurysm remains unchanged, because the risk of surgery has decreased recently owing to new techniques for neuronavigation.- - - - - - - - - - ranking = 15keywords = aneurysm (Clic here for more details about this article) |
3/56. radiation-induced aneurysm and moyamoya vessels presenting with subarachnoid haemorrhage.A rare case of a ruptured internal carotid artery (ICA) aneurysm, with ICA stenosis and moyamoya vessels, was diagnosed in a young female patient after radiotherapy for optic glioma. Retrospective analysis revealed that an extraordinarily high dose of radiation (110 Gy) had been delivered to the area around the ICA in two therapeutic sessions. Clipping and wrapping of the aneurysm were performed and the patient made a good recovery. A review of the literature suggested that rupture of radiation-induced aneurysms is a rare event, but may be fatal. Considerable care must therefore be taken when delivering high-dose radiation to cerebral arteries. We suggest that the incidence of radiation-induced moyamoya vessels is higher in younger patients.- - - - - - - - - - ranking = 7keywords = aneurysm (Clic here for more details about this article) |
4/56. Moyamoya-like vasculopathy from cocaine dependency.We herein describe two cases of moyamoya vasculopathy occurring in two men who used alkaloidal cocaine for years. One patient presented with aneurysmal subarachnoid hemorrhage and one with infarction in both lobes. Particularly impressive was a significant degree of collateral development with lenticulostriate networks.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
5/56. Endovascular treatment of basilar tip aneurysm associated with moyamoya disease--case report.A 58-year-old female was admitted unconscious to a local hospital. Computed tomography demonstrated subarachnoid hemorrhage. cerebral angiography revealed evidence of moyamoya disease and a saccular aneurysm at the tip of the basilar artery. The patient was transferred to our hospital for embolization of the basilar tip aneurysm. Endovascular embolization was performed using Guglielmi detachable coils (GDCs), and the aneurysm was completely occluded with preservation of the parent artery. No change in the patient's neurological status was seen during and after the procedure. Endovascular treatment using GDCs appears to be particularly suitable for ruptured cerebral saccular aneurysms in patients with moyamoya disease.- - - - - - - - - - ranking = 8keywords = aneurysm (Clic here for more details about this article) |
6/56. Distal anterior choroidal artery aneurysm in a patient with moyamoya disease: case report.OBJECTIVE AND IMPORTANCE: Distal anterior choroidal artery (AChA) aneurysms in moyamoya disease are rare, with few surgically verified reported cases. CLINICAL PRESENTATION: We report a rare case of distal AChA aneurysm associated with moyamoya disease in a 48-year-old man who presented with vomiting and severe headache. Computed tomographic scans revealed an intracerebral hematoma in the right temporoparietal lobe and a diffuse intraventricular hemorrhage. INTERVENTION: The hematoma was removed via computed tomography-guided stereotactic aspiration and ventricular drainage. cerebral angiography showed a saccular aneurysm located at the distal branch of the right AChA. By means of magnetic resonance imaging, a small signal void lesion was detected in the periventricular area lateral to the trigone of the right lateral ventricle. The aneurysm was accurately accessed via a parietal cortical incision by use of magnetic resonance imaging-guided stereotactic localization. The aneurysm was successfully resected after undergoing trapping of the parent artery, and when the patient was discharged, he had no evidence of neurological deficit. The aneurysm was histologically verified to be a true aneurysm. CONCLUSION: Direct surgery should be considered in cases of ruptured distal AChA aneurysms located in the periventricular or intraventricular regions.- - - - - - - - - - ranking = 12keywords = aneurysm (Clic here for more details about this article) |
7/56. Supracerebellar transtentorial approach to posterior temporomedial structures.The supracerebellar transtentorial (SCTT) approach, a modification of the infratentorial supracerebellar approach, facilitates simple and minimally invasive access to posterior temporomedial structures without requiring retraction of the temporal or occipital lobe. The SCTT approach was used in 16 patients over a 3-year period. Eleven patients harbored tumors confined to, or located mainly within, the posterior hippocampal formation, three patients harbored aneurysms (one ruptured posterior cerebral artery [PCA] aneurysm at the P2-P3 junction, one ruptured giant PCA [P2] aneurysm, and one giant basilar artery-superior cerebellar artery aneurysm), one patient had juvenile-type moyamoya disease, and one patient suffered from medically intractable epilepsy. In these patients, the SCTT approach enabled tumor removal, aneurysm clipping, and vascular bypass procedures. The authors' experience suggests that this approach can be used routinely in treating lesions in the posterior temporomedial region.- - - - - - - - - - ranking = 5keywords = aneurysm (Clic here for more details about this article) |
8/56. Spontaneous middle cerebral artery occlusion leading to moyamoya phenomenon and aneurysm formation on collateral arteries.BACKGROUND: Spontaneous middle cerebral artery occlusion associated with moyamoya phenomenon is distinct from moyamoya disease. The hemodynamic stress on the collateral channel occasionally leads to aneurysm formation, which may manifest as hemorrhage. The etiology of this disease has not been fully understood. CASE DESCRIPTION: A 63-year-old woman presented with left putaminal hemorrhage. The cerebral angiogram revealed a significant stenosis in the proximal segment of the left middle cerebral artery. Collateral arteries originating from the horizontal segment of the ipsilateral anterior cerebral artery and the ambient segment of the ipsilateral posterior cerebral artery supplied the middle cerebral artery distal to the stenosis. Both of the collateral channels had associated aneurysms that were surgically obliterated. The aneurysm on the collateral artery from the posterior cerebral artery was responsible for the putaminal hemorrhage. CONCLUSIONS: Spontaneous middle cerebral artery occlusion may lead to focal moyamoya phenomenon and aneurysmal intracerebral, intraventricular, or subarachnoid hemorrhage. The presence of a co-existing anomalous collateral artery in the present case suggests a congenital etiology of the focal middle cerebral artery occlusion.- - - - - - - - - - ranking = 8keywords = aneurysm (Clic here for more details about this article) |
9/56. Effects of surgical revascularization on peripheral artery aneurysms in moyamoya disease: report of three cases.OBJECTIVE AND IMPORTANCE: The beneficial effects of surgical revascularization on rebleeding in moyamoya disease remain unclear. This report is intended to clarify the effects of surgical revascularization on peripheral artery aneurysms, which represent one of the causes of intracranial bleeding in moyamoya disease. CLINICAL PRESENTATION: Findings for three female patients who experienced intracranial bleeding are presented. cerebral angiography revealed that intracranial bleeding resulted from the rupture of peripheral artery aneurysms arising from dilated collateral vessels such as the lenticulostriate artery. INTERVENTION: The patients successfully underwent superficial temporal artery-middle cerebral artery anastomosis combined with encephaloduromyoarteriosynangiosis. Angiography demonstrated obliteration of the peripheral artery aneurysms, together with the disappearance or decrease in caliber of the parent collateral arteries, after surgery. None of the patients experienced rebleeding during the follow-up period (up to 52 mo). CONCLUSION: The results strongly suggest that surgical revascularization potentially improves cerebral circulation and decreases hemodynamic stress on collateral vessels, obliterating peripheral artery aneurysms.- - - - - - - - - - ranking = 8keywords = aneurysm (Clic here for more details about this article) |
10/56. Intraaneurysmal embolization of an unruptured basilar tip aneurysm associated with moyamoya disease.We describe a patient with moyamoya disease associated with an unruptured basilar tip aneurysm which was treated by endovascular embolization using Guglielmi detachable coils (GDCs). A 53-year-old man presented with left hemiparesis persisting for 3 mon ths before admission. cerebral angiography revealed occlusion of the bilateral middle cerebral arteries and the left anterior cerebral artery, stenosis of the right anterior cerebral artery, and basal moyamoya vessels. In addition, a saccular small aneurysm was seen at the top of the basilar artery. The aneurysm was completely embolized by intraaneurysmal GDCs. Direct surgical clipping is often selected for the treatment of posterior fossa aneurysms in moyamoya disease. However, complete clipping is usually difficult due to the difficulties in operative technique associated with moyamoya disease. We suggest that the endovascular treatment using GDCs is comparatively safe and effective for the treatment of surgically difficult aneurysms in patients with moyamoya disease.- - - - - - - - - - ranking = 14keywords = aneurysm (Clic here for more details about this article) |
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