Treatment and prognosis of intracranial aneurysms associated with hemorrhagic moyamoya disease

Objective To investigate the treatment and prognosis of intracranial aneurysms associated with hemorrhagic moyamoya disease. Methods Ten patients(12 aneurysms) with aneurysms associated with hemorrhagic moyamoya disease were included. Of the 12 aneurysms diagnosed by DSA, 7 were found distributed around the circle of Willis, 2 in the basal ganglia and 3 on the collateral vessels.Nine aneurysms were ruptured and 3 were unruptured. Six of the 7 aneurysms around the circle of Willis were treated by endovascular embolization or surgical clipping, while the remaining 1 case was treated conservatively.Two aneurysms in the basal ganglia were managed with conservative treatment.Of the 3 aneurysms on the collateral vessels, 2 were occluded by 33% Glubran glue injection, 1 was treated conservatively. Results (1)Six aneurysms around the circle of Willis were successfully and completely occluded or clipped.The other 1 patient was managed with conservative treatment and the aneurysm was stable.Two aneurysms in the basal ganglia were followed up conservatively and disappeared 3 and 8 months later, respectively.Two of the 3 aneurysms on the collateral vessels got complete embolization.The patient treated conservatively experienced a second episode of bleeding and died 14 days after the first hemorrhage.(2)Outcome was assessed using the modified Rankin scale (mRS) when patients discharged, 0 point in 5 cases, 1 in 2 cases, 2 in 1 case, 3 in 1 case, 4 in 0 case and 6 in 1 case.(3)The follow-up period of the 9 patients was between 2 to 36 months. Re-examination by DSA revealed no recurrence of the aneurysms occluded or clipped and the aneurysms disappearing spontaneously.The aneurysm treated conservatively remained stationary. Conclusions Patients with different types of aneurysms associated with moyamoya disease should undergo different treatments, which may be more appropriate and more effective. Key words: Moyamoya disease; Intracranial aneurysm; Hemorrhage; Treatment protocols