Coil embolization for post-bypass aneurysm of middle meningeal artery for moyamoya disease - preservation of transdural anastomosis

Kunitaka Maruyama; Daina Kashiwazaki; Shusuke Yamamoto; Naoki Akioka; Emiko Hori; Satoshi Kuroda

doi:10.25259/SNI_224_2023

Coil embolization for post-bypass aneurysm of middle meningeal artery for moyamoya disease - preservation of transdural anastomosis

Surg Neurol Int. 2023 Apr 28:14:157. doi: 10.25259/SNI_224_2023. eCollection 2023.

Authors

Kunitaka Maruyama¹, Daina Kashiwazaki¹, Shusuke Yamamoto¹, Naoki Akioka², Emiko Hori², Satoshi Kuroda²

Affiliations

¹ Department of Neurosurgery, Toyama University Hospital, Sugitani, Toyama, Japan.
² Department of Neurosurgery, University of Toyama, Sugitani, Toyama, Japan.

Abstract

Background: Middle meningeal artery (MMA) pseudoaneurysm following revascularization surgery for moyamoya disease (MMD) is rare.

Case description: Here, a 29-year-old man presented with an MMA pseudoaneurysm after he underwent revascularization surgery (superficial temporal artery-to-middle cerebral artery bypass and encephalo-duro-myoarterio-pericranial synangiosis) for hemorrhagic MMD. At 3 months post-surgery, digital subtraction angiography showed a pseudoaneurysm in the right MMA. Transdural anastomosis to the parietal and occipital lobes was opacified at the distal MMA of the pseudoaneurysm. Intra-aneurysmal coil embolization was performed for preservation of transdural anastomosis. The postoperative course was uneventful. At 1 month post-embolization, angiography revealed an entirely occluded pseudoaneurysm.

Conclusion: An increase in blood flow in the MMA due to bypass surgery may accelerate aneurysm development by increasing the hemodynamic stress. This case suggested that intra-aneurysmal embolization may be a potential treatment.

Keywords: Endovascular treatment; Moyamoya disease; Pseudoaneurysm.

Publication types

Case Reports