Abstract
We report 3 cases of ruptured basilar artery aneurysms associated with adult moyamoya disease and review an additional 29 cases of basilar artery aneurysms associated with moyamoya disease in the literature.
A 37-year-old woman with aneurysms at the basilar bifurcation and the junction of the left superior cerebellar and basilar artery was successfully treated with intentionally delayed aneurysm obliteration by the subtemporal approach on Day 16 after bleeding. Two other cases died after rerupture of basilar artery aneurysms. A 52-year-old woman developed rerupture on Day 11 followed by a fatal rupture on Day 24, and a 51-year-old man developed rerupture on Day 12 followed by a fatal rupture 11 years later.
Twenty-one (66%) of the 32 cases we reviewed bled from basilar artery aneurysms and 11 cases (34%) had multiple saccular aneurysms. Of 12 non-surgical cases, 5 patients (42%) died of aneurysm rerupture or angiospasm, 5 (56%) of 9 cases with aneurysmal bleeding developed rerupture. Of the 20 cases treated by open surgery (17 cases) or endovascular surgery (3 cases), 12 patients (60%) had a good outcome, 4 patients (20%) died and 2 patients each developed a moderate or severe disability. All these disabilities were caused by intracerebral hemorrhage itself.
Thus, basilar artery aneurysms associated with moyamoya disease should be treated surgically. However, the procedures should be carefully selected; early surgery for aneurysm obliteration can be applied to patients with a good preoperative grade (Grade 1 or 2), delayed surgery to patients with a poor preoperative grade (higher than Grade 2), and endovascular surgery to patients with nonruptured large aneurysm or poor risk.
