Abstract
Objective: We report two patients with moyamoya disease and a ruptured distal posterior choroidal artery(PChA) aneurysm successfully treated with endovascular embolization.
Case Presentations: Patient 1 was a 49-year-old female who presented with headache and vomiting. Imaging studies revealed intraventricular hemorrhage and a hematoma in the corpus callosum due to rupture of a distal medial PChA aneurysm. Aneurysmal embolization was performed using n-butyl cyanoacrylate (NBCA). The patient tolerated well and was discharged home on day 34 with a modified Rankin Scale score of 1. Patient 2 was a 46-year-old female who presented with consciousness disturbance. Imaging studies revealed intraventricular hemorrhage with hydrocephalus due to rupture of a distal lateral PChA aneurysm. Bilateral ventricular drainage and NBCA embolization were concomitantly performed in our hybrid operating room. Neuroendoscopic hematoma evacuation was performed the following day. Ventricular drainage was discontinued a few days later. The patient was eventually discharged home after spending several months in rehabilitation.
Conclusion: Embolization of ruptured PChA aneurysms in patients with moyamoya disease can be safe and effective. Embolization of these aneurysms requires an understanding of the vascular anatomy, particularly the anastomoses between the anterior and posterior choroidal arteries and cortical branches.
