Clinical observation of encephalo-duro-arterio-synangiosis or in combination with endovascular embolization for patients with moyamoya disease complicating intracranial aneurysms / 中国脑血管病杂志

ABSTRACT

Objectives: To observe the efficacy of encephalo-duro-arterio-synangiosis (EDAS) or in combination with endovascular embolization in the treatment of patients with moyamoya disease complicating intracranial aneurysms and to investigate the therapeutic strategy for moyamoya disease complicating intracranial aneurysms. Methods: A total of 27 patients (28 aneurysms) with moyamoya disease complicating intracranial aneurysms confirmed by cerebral angiography were recruited. Nineteen patients were presented as hemorrhagic disease and 8 patients were presented as cerebral ischemic disease. For 10 patients with arterial trunk aneurysms, they were treated with endovascular embolization, and then were treated with unilateral EDAS 7-10 days after embolization. Three months later the contralateral EDAS were performed. As for the aneurysms located in the peripheral arteries (n = 17) , if the embolization could be performed (n =9), the aneurysms were obliterated with coils or ONYX glue, otherwise the ipsilateral EDAS should be performed (n = 8). Results: Circled digit oneEighteen aneurysms in 19 patients (20 aneurysms) were embolized successfully and 2 patients were failed (one aneurysm in lenticulostriate artery and the other in posterior choroidal artery). After embolization, 3 patients with peripheral aneurysms had contralateral limb weakness, and recovered within 1 week to 3 months. Circled digit twoThere was no bleeding and rebleeding for 10-60 months follow-up after EDAS. Among the patients with cerebral ischemia, 2 had recurrence of TIA within 3 months after EDAS, but they had no recurrence of the symptom after 3 months. Circled digit threeThe angiography of 21 patients (21 aneurysms) 3 to 15 months after EDAS showed that the aneurysms treated with embolization did not reoccur (12 aneurysms); 8 of 9 peripheral aneurysms without eml)olization were disappeared; and significant retention of contrast agent in 1 aneurysm was found. All 21 patients showed better communication between the superficial temporal artery and intracranial angiogenesis. Conclusion: Endovascular embolization is one of the important means for the treatment of moyamoya disease complicating intracranial aneurysms. EDAS may promote the occlusion of peripheral aneurysms.