Surgical Management of a Ruptured Posterior Choroidal Intraventricular Aneurysm Associated with Moyamoya Disease Using Frameless Stereotaxy: Case Report and Review of the Literature

M. Jafer Ali, Bernard R. Bendok, Christopher C. Getch, Numa R. Gottardi-Littell, Stefan Mindea, H. Hunt Batjer, Michael Stoffman, Murat Gunel, Sam P. Javedan, Robert F. Spetzler, Daniel L. Barrow, Christopher S. Ogilvy

Research output: Contribution to journalReview article

24 Scopus citations

Abstract

OBJECTIVE AND IMPORTANCE: Prevention of rebleeding is the most important aspect of the management of hemorrhagic moyamoya disease, because rebleeding causes significant morbidity and mortality. CLINICAL PRESENTATION: A 26-year-old male patient with a history of moyamoya disease since the age of 3 years and multiple strokes was in a semicomatose state at presentation. He was found to have intraventricular and periventricular hemorrhages abutting the atrium of the right ventricle. His hospital course was complicated by a second hemorrhage. Both bleeding events were believed to be secondary to a ruptured right lateral posterior choroidal aneurysm. INTERVENTION: The aneurysm was excised and revealed histopathology consistent with a true saccular aneurysm. Frameless stereotactic guidance was used during surgery to minimize damage to collateral vessels and to shorten the surgical corridor. CONCLUSION: The management of hemorrhagic moyamoya disease should be modified based on the source of hemorrhage and its relation to a specifically located aneurysm. In the case of aneurysms arising from the choroidal artery, the general belief is that most of these represent pseudoaneurysms and have a tendency to regress spontaneously. Because of the rebleeding risk, we recommend early intervention in treating ruptured intracranial aneurysms using the least invasive surgical techniques.

Original languageEnglish (US)
Pages (from-to)1019-1024
Number of pages6
JournalNeurosurgery
Volume54
Issue number4
DOIs
StatePublished - Apr 2004

Keywords

  • Choroidal artery aneurysm
  • Intracranial hemorrhage
  • Moyamoya disease
  • Periventricular aneurysm
  • Rebleeding

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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