Clinical Features And Outcomes Of Intracranial Aneurysms Associated With Moyamoya Disease

Objective : We aim to describe clinical features 、 the effects of different treatments on prognosis of intracranial aneurysms accompanied with moyamoya disease.METHODS : The total 104 patients with moyamoya disease(MMD)or moyamoya syndrome associated with aneurysms diagnosed by DSA or CTA,who admitted to the First Affiliated Hospital of Nanchang University between January 2007 and December 2015 were retrospectively analyzed.Follow-up data were obtained by hospital recording or telephone interview.Results : There were 1299 patients with MMD.Among them,104 cases accompanied with intracranial aneurysms.Accounting for 8% of moyamoya disease.The ratio of men to women was 1:1(52/52).The mean(± SD)patient age was 49.67± 10.03 year(range 29-78).These 104 cases had 129 aneurysms.The distribution of the aneurysms as follows: anterior communicating artery aneurysms 28(21.71%),basilar artery aneurysms 21(16.28%),middle cerebral artery aneurysms 19(14.73%),posterior cerebral artery aneurysms 17(13.18%),internal carotid artery aneurysms 12(9.30%),posterior communicating artery aneurysms 11(8.53%),anterior cerebral artery aneurysms 10(7.75%),anterior choroidal artery aneurysms 5(3.88%),moyamoya vessel aneurysms 2(1.55%),other location aneurysms 4(3.1%).anterior circulation aneurysms 89(68.99%),posterior circulation aneurysms 40(31.01%).82 cases(78.85%)had one aneurysm.21 cases(20.19%)had two or more aneurysms.The number and location of aneurysm in the last one case was unknowing.64 cases were treated surgically,40 cases conservatively.The mean follow-up time was 38 months.81 of 104 cases were followed up successfully,23 lost of follow up.57 of 81 cases(70.37%)had a good outcome.2 cases(2.47%)were in paralyzed.22 cases were died.The mortality rate was(27.16%).Death occurred in 16(47.06%)of 34 patients treated with conservative treatment,6(12.77%)of 47 patients treated with surgical treatment.7 cases(8.64%)had twice cerebral hemorrhage.one case(1.23%)had third cerebral hemorrhage.Rehemorrhage rate was 9.88%.There were 5 death,two good outcome,one coma among 8 cases who experienced rehemorrhage.The mortality rate of rehemorrhage was up to 62.5%.Conclusion:The incidence in posterior circulation of aneurysms associated with moyamoya disease was significantly increased.The rehemorrhage rate was high.The mortality rate was extremely high after rehemorrhage.Positive surgical treatment has clinical significance for forbidding rehemorrhage and reducing mortality.