Moyamoya vessels associated with multiple cerebral aneurysms. Report of a surgically treated case and review of the literature

A case of multiple cerebral aneurysms associated with so-called moyamoya disease is reported. The patient was a 52-year-old male attacked by subarachnoid hemorrhage. The patient was confused and signs of meningeal irritation were noted. Computed tomography (CT) scan showed the ventricular hemorrhage. Right carotid angiogram showed moyamoya vessels in the basal ganglia. The other angiograms showed three aneurysms, which were located at the origin of the posterior communicating artery (ICA-PCA) on the left, at the posterior cerebral-posterior communicating artery origin (PCA-PcomA) on the right, and the distal site of the posterior choroidal artery (PchA) on the left. Two aneurysms located at the origin of PCA and ICA were clipped by the transsylvian approach, the former being reached through the moyamoya vessels. Spontaneous regression of an aneurysm at the peripheral portion of PchA were angiographically documented 10 days after the second operation. There were no changes around the basal ganglia on post-operative CT. Histological examination of a part of the flat and small middle cerebral artery (M1) gained during operation revealed proliferation of intima, elongated elastica interna and loss of media. Forty-four reported cases of so-called moyamoya disease with aneurysm were discussed. As for operative indication of the aneurysm associated with moyamoya vessels, the authors consider that the aneurysm classified after Okamoto, et al. as Type III or major artery aneurysm, was almost saccular and the operative approach does not always injure moyamoya vessels.