Ninomiya Atsuhiko, Endo Hidenori, Tashiro Ryosuke, Kanoke Atsushi, Tominaga Teiji
1Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
2Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and.
J Neurosurg Case Lessons. 2023 Mar 20;5(12). doi: 10.3171/CASE2365.
Moyamoya disease (MMD) is linked to the formation of intracranial aneurysms. The authors recently observed an effective use of magnetic resonance vessel wall imaging (MR-VWI) to detect de novo unruptured MMD-associated microaneurysms.
The authors describe a 57-year-old female who was diagnosed with MMD 6 years ago after suffering a left putaminal hemorrhage. MR-VWI revealed point-like enhancement in the right posterior paraventricular region during the annual follow-up. On the T2-weighted image, this lesion was surrounded by high intensity. Angiography revealed a microaneurysm in the periventricular anastomosis. Right combined revascularization surgery was performed to prevent future hemorrhagic events. Another de novo circumferential enhanced lesion on MR-VWI appeared in the left posterior periventricular region 3 months after surgery. Angiography revealed that the enhanced lesion was a de novo microaneurysm on the periventricular anastomosis. The left combined revascularization surgery went well. The bilateral microaneurysms vanished on follow-up angiography.
Unruptured MMD-associated microaneurysms on the periventricular anastomosis can be detected using MR-VWI. Revascularization surgery can eliminate microaneurysms by reducing hemodynamic stress on the periventricular anastomosis.
烟雾病（MMD）与颅内动脉瘤的形成有关。作者最近观察到磁共振血管壁成像（MR-VWI）在检测初发未破裂的MMD相关微动脉瘤方面的有效应用。
作者描述了一名57岁女性，6年前因左侧壳核出血被诊断为烟雾病。在年度随访期间，MR-VWI显示右后室旁区域有点状强化。在T2加权图像上，该病变被高强度信号包围。血管造影显示脑室周围吻合处有一个微动脉瘤。进行了右侧联合血运重建手术以预防未来的出血事件。术后3个月，MR-VWI上在左后室旁区域出现另一个新的环状强化病变。血管造影显示该强化病变是脑室周围吻合处的一个初发微动脉瘤。左侧联合血运重建手术进展顺利。随访血管造影显示双侧微动脉瘤消失。
使用MR-VWI可检测脑室周围吻合处未破裂的MMD相关微动脉瘤。血运重建手术可通过减轻脑室周围吻合处的血流动力学压力来消除微动脉瘤。
