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Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention.

Amin-Hanjani S, Goodin S, Charbel FT, Alaraj A - Surg Neurol Int (2014)

Bottom Line: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint.Alternatively, superficial temporal artery-middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood St., M/C799, Chicago, IL, USA.

ABSTRACT

Background: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery-middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.

Case description: Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.

Conclusions: A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.

No MeSH data available.


Related in: MedlinePlus

(a, b)Vertebral artery (VA) DSA AP and lateral views demonstrating an unruptured aneurysm (arrow) on a collateral from the left PCA to the left anterior cerebral artery (ACA) and left MCA. (c, d) Selective DSA imaging, AP and lateral views, through a microcatheter introduced through the left PCA. A small 3-mm aneurysm (long arrow) is seen supplied by the posterior choroidal branch of the PCA. There is reconstitution of ACA and MCA (short arrows) from the aneurysm feeding vessels
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Figure 2: (a, b)Vertebral artery (VA) DSA AP and lateral views demonstrating an unruptured aneurysm (arrow) on a collateral from the left PCA to the left anterior cerebral artery (ACA) and left MCA. (c, d) Selective DSA imaging, AP and lateral views, through a microcatheter introduced through the left PCA. A small 3-mm aneurysm (long arrow) is seen supplied by the posterior choroidal branch of the PCA. There is reconstitution of ACA and MCA (short arrows) from the aneurysm feeding vessels

Mentions: Follow-up angiography was performed 1 year post embolization. The right-sided aneurysm remained well obliterated. The left internal carotid artery (ICA) injection showed occlusive changes in the supraclinoid ICA with typical moya collaterals, in addition to the finding of a pseudoaneurysm arising from a collateral vessel just lateral to the third ventricle. In retrospect, it was noted that the lesion had likely been present previously but had become substantially more prominent [Figure 2a, b]. Subsequently, embolization was attempted; however, the aneurysm was originating from a deep choroidal branch arising from the left posterior cerebral artery (PCA), which was seen to be directly reconstituting cortical vasculature, including the distal MCA [Figure 2c, d]. Because of the risk of interruption of this collateral supply to the MCA, the aneurysm was not embolized.


Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention.

Amin-Hanjani S, Goodin S, Charbel FT, Alaraj A - Surg Neurol Int (2014)

(a, b)Vertebral artery (VA) DSA AP and lateral views demonstrating an unruptured aneurysm (arrow) on a collateral from the left PCA to the left anterior cerebral artery (ACA) and left MCA. (c, d) Selective DSA imaging, AP and lateral views, through a microcatheter introduced through the left PCA. A small 3-mm aneurysm (long arrow) is seen supplied by the posterior choroidal branch of the PCA. There is reconstitution of ACA and MCA (short arrows) from the aneurysm feeding vessels
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109168&req=5

Figure 2: (a, b)Vertebral artery (VA) DSA AP and lateral views demonstrating an unruptured aneurysm (arrow) on a collateral from the left PCA to the left anterior cerebral artery (ACA) and left MCA. (c, d) Selective DSA imaging, AP and lateral views, through a microcatheter introduced through the left PCA. A small 3-mm aneurysm (long arrow) is seen supplied by the posterior choroidal branch of the PCA. There is reconstitution of ACA and MCA (short arrows) from the aneurysm feeding vessels
Mentions: Follow-up angiography was performed 1 year post embolization. The right-sided aneurysm remained well obliterated. The left internal carotid artery (ICA) injection showed occlusive changes in the supraclinoid ICA with typical moya collaterals, in addition to the finding of a pseudoaneurysm arising from a collateral vessel just lateral to the third ventricle. In retrospect, it was noted that the lesion had likely been present previously but had become substantially more prominent [Figure 2a, b]. Subsequently, embolization was attempted; however, the aneurysm was originating from a deep choroidal branch arising from the left posterior cerebral artery (PCA), which was seen to be directly reconstituting cortical vasculature, including the distal MCA [Figure 2c, d]. Because of the risk of interruption of this collateral supply to the MCA, the aneurysm was not embolized.

Bottom Line: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint.Alternatively, superficial temporal artery-middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood St., M/C799, Chicago, IL, USA.

ABSTRACT

Background: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery-middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.

Case description: Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.

Conclusions: A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.

No MeSH data available.


Related in: MedlinePlus