Endovascular embolization of ruptured subependymal artery aneurysm associated with moyamoya disease: a case report

Abstract

Objective: We describe a rare case of ruptured subependymal artery (SEA) aneurysm associated with moyamoya disease. Aneurysm was embolized using n-butyl cyanoacrylate (NBCA).
Case presentation: A 26-year-old female presented with intraventricular hemorrhage. The CTA showed poorly developed main trunk of the right middle cerebral artery (MCA) and an aneurysm in the lateral ventricle. We suspected moyamoya disease. The angiography showed twig-like networks and aplastic main trunk of the right MCA, also visualizing an aneurysm at the right SEA. The right posterior communicating artery was of the fetal type, and the enlarged right SEA originated from the extension of right anterior choroidal artery (AChA). A microcatheter was navigated into the SEA via the AChA and then 25% NBCA was injected until complete occlusion. The post treatment MRI showed no ischemic lesion. The patient was discharged neurologically intact.
Conclusion: Endovascular embolization is an attractive treatment for aneurysms associated with moyamoya disease. Our case was a valuable experience in the management of such lesions, considering the pathophysiology of the existing plexiform vascular network.