Endovascular treatment of ruptured aneurysms or pseudoaneurysms on the collateral vessels in patients with moyamoya disease.

Abstract

Ruptured aneurysms or pseudoaneurysms on the collateral vessels in patients with moyamoya disease have been known to be difficult to treat surgically because of their deep location and combined ischemic condition of the brain. For several years, we have treated these aneurysms by endovascular means. In this article, we describe the detailed techniques and outcomes. Eight patients with moyamoya disease who presented with intracerebral or intraventricular hemorrhage were treated by endovascular embolization. All had small aneurysmal lesions on distal collateral arteries (the distal part of the anterior and lateral posterior choroidal artery as periventricular collaterals in 7 patients and a small collateral branch from anterior communicating artery in 1 patient) that were located at corresponding area to the hemorrhage demonstrated on angiography. After superselecting the arteries as distally as possible, the aneurysms were occluded by n-butyl-cyanoacrylate injection. Seven of 8 aneurysms were successfully and completely occluded without complication. One failed due to a small artery. Neither additional neurological deficit nor newly developed infarction was observed during the follow-up period. Clinically, 6 of the 8 patients demonstrated complete recovery. No further bleeding occurred during the follow-up period (mean, 24 months; range, 11-60 months). Although further investigation is required to determine many aspects of this treatment, including indication, safety, and efficacy, the endovascular occlusion of aneurysms on the collateral vessels in moyamoya disease with glue could be an effective treatment option.