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Abstract - Case Report

J Cerebrovasc Endovasc Neurosurg. 2023 25(1): 75-80
¨Ï The Journal of Cerebrovascular and Endovascular Neurosurgery
      
 
Hydration-induced rapid growth and regression after indirect revascularization of an anterior choroidal artery aneurysm associated with Moyamoya disease: A case report
Gi Yeop Lee1, Byung-Kyu Cho1, Sung Hwan Hwang1, Haewon Roh1, Jang Hun Kim2
1Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Korea 2Department of Neurosurgery, Korea University Anam Hospital, Seoul, Korea

The prevalence of aneurysm formation in adults with Moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient¡¯s disease characteristics. A 22-year-old man was diagnosed with MMD after presenting a small thalamic intracerebral and subarachnoid hemorrhage in the quadrigeminal cistern. Cerebral angiography revealed a small aneurysm (2.42 mm) in the left anterior choroidal artery. Since the hemodynamics in the left hemisphere was compromised, an indirect bypass surgery was performed. The patient¡¯s condition deteriorated postoperatively because of poor perfusion of the internal carotid artery, and massive hydration was required. During neurocritical care, the aneurysm increased in size (5.33 mm). An observation strategy was adopted because of the distal aneurysmal location and the high risk involved. Subsequently, the patient recovered, and newly developed collateral flow appeared from the external carotid artery. Additionally, a dramatic size reduction of the aneurysm (1.51 mm) was noticed. Our case suggests that MMD-related dissecting aneurysms on a distal cerebral artery, which present a high risk of embolization, could be managed by indirectly reducing the hemodynamic burden. Massive hydration in such cases should be avoided or balanced to avoid the risk of rapid growth and aneurysm rupture. Keywords¡¡‌Moyamoya disease, Intracranial aneurysm, Anterior choroidal artery, Pseudoaneurysm
 
Key words : Moyamoya disease, Intracranial aneurysm, Anterior choroidal artery, Pseudoaneurysm
 
 
    
 
 
 

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