片側型もやもや病に合併した破裂遠位前大脳動脈瘤の1例

抄録

Peripheral aneurysms with moyamoya disease are known to be a source of intracranial hemorrhage; they either disappear spontaneously or re-bleed repeatedly. There is no consensus on treatment for these aneurysms. We report a case of ruptured peripheral cerebral aneurysm in abnormal vessels associated with moyamoya disease in a 36-year-old man who presented with intraparenchymal hemorrhage in genu of the corpus callosum associated with intraventricular extension and thin subarachnoid hemorrhage. Cerebral angiography showed a saccular aneurysm (2.5 mm maximum diameter) with a daughter sac at right A2/A3, occlusion of the supraclinoid portion of the left internal carotid artery, and abundant ipsilateral moyamoya vessels. On day 17, we performed aneurysmal neck clipping. After surgery, neither symptomatic cerebral vasospasm nor hydrocephalus occurred. The patient was discharged without any neurological deficits. Some peripheral cerebral aneurysms associated with moyamoya disease regress spontaneously, whereas others may show rebleeding. Surgical treatment should be considered if the aneurysm expands, or at least does not shrink, on imaging.