Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2020 Jun;138:e749-e758. doi: 10.1016/j.wneu.2020.03.072. Epub 2020 Mar 19.
Intracranial aneurysms (IA) are associated with moyamoya disease (MMD). There are no clinically tested treatment guidelines. Reporting of cases is vital to better understand the underlying pathophysiology and potential ethnic predispositions and improve patient selection for intervention.
Records of all patients diagnosed with MMD with concomitant IA who presented to our institution were retrospectively reviewed. Data related to demographic, clinical, MMD characteristics, aneurysm characteristics, surgical intervention, and follow-up were collected from the records of each patient. Aneurysm location was categorized into circle of Willis (CoW) aneurysms (originating from the CoW or its major branches) and peripheral aneurysms (arising from choroidal or lenticulostriate arteries).
Ten patients were found to have a total of 14 IA. All patients were white. Ten aneurysms (71%) were classified as CoW aneurysms and 4 (29%) were classified as peripheral. Seven of 10 CoW aneurysms (70%) were located in the anterior circulation, whereas 3 (30%) were located in the posterior circulation. Aneurysms of anterior and posterior circulations were most commonly treated with coil embolization, whereas peripheral artery aneurysms were most commonly treated with either cerebral revascularization alone or aneurysm excision.
Revascularization surgery seems to be an effective method of indirectly treating IA in patients with MMD. Previous literature in addition to our series shows that endovascular embolization is safe and efficacious in treating IA of most locations in patients with MMD. The use of open microsurgery for direct aneurysm treatment in this population poses many challenges.
颅内动脉瘤（IA）与烟雾病（MMD）有关。目前尚无经过临床验证的治疗指南。报告病例对于更好地了解潜在的病理生理学和潜在的种族易感性，并改善介入治疗的患者选择至关重要。
回顾性分析我院收治的并发颅内动脉瘤的 MMD 患者的病历资料。从每位患者的病历中收集与人口统计学、临床、MMD 特征、动脉瘤特征、手术干预和随访相关的数据。动脉瘤位置分为 Willis 环（CoW）动脉瘤（起源于 CoW 或其主要分支）和周围动脉瘤（起源于脉络膜或纹状体动脉）。
共发现 10 例患者共 14 个 IA。所有患者均为白人。10 个动脉瘤（71%）归类为 CoW 动脉瘤，4 个（29%）归类为周围动脉瘤。10 个 CoW 动脉瘤中的 7 个（70%）位于前循环，3 个（30%）位于后循环。前循环和后循环的动脉瘤多采用线圈栓塞治疗，而周围动脉的动脉瘤多采用单独的脑血管重建或动脉瘤切除治疗。
血管重建手术似乎是一种治疗 MMD 患者 IA 的有效方法。除了我们的系列研究外，既往文献还表明，血管内栓塞治疗 MMD 患者大多数部位的 IA 是安全有效的。对于该人群，开颅显微手术直接治疗动脉瘤存在诸多挑战。
