Cerebral revascularization combined with aneurysm clipping or embolization for the treatment of moyamoya disease complicated with ruptured aneurysms

Objective To evaluate the safety and short-term efficacy of cerebral revascularization combined with aneurysm clipping or embolization for the treatment of moyamoya disease complicated with ruptured aneurysms. Methods Five moyamoya patients(6 aneurysms) with ruptured aneurysm underwent cerebral revascularization combined with aneurysm clipping or embolization from December 2015 to October 2017 at Department of Neurosurgery, Nanfang Hospital, Southern Medical University. Two patients were treated by STA-MCA bypass combined with endovascular embolization of aneurysm. Three patients (4 aneurysms) were treated with aneurysm clipping and EC-IC revascularization. Results Intraoperative DSA revealed total obligation of the 4 clipped aneurysms and the other 2 embolized peripheral aneurysms. All of the 5 bypass grafts showed good patency. The 5 patients recovered well after surgery although 1 patient showed asymptomatic infarction on post-operative MRI. All patients received clinical follow-up (5-24 months) and were evaluated with the Glasgow outcome scale(GOS). Five patients showed good outcome (GOS Ⅴ or Ⅳ grade). Five patients received MRA follow-up. Three out of them received both DSA and MRA follow-up and showed no reoccurrence of aneurysm and good patency of the graft. Conclusion Cerebral revascularization combined with aneurysm clipping or embolization could be effective for moyamoya diseases with ruptured cerebral aneurysms and showed good short-term results. Key words: Moyamoya disease; Aneurysm, ruptured; Embolization, therapeutic; Microsurgery; Cerebral revascularization