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Spontaneous occlusion of ruptured microaneurysm formed on postoperative transosseous anastomosis after indirect revascularization in a patient with moyamoya disease

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Abstract

A 40-year-old female with a history of ischemic moyamoya disease treated with indirect revascularization at ages 12 and 25 years presented with a sudden severe headache. Imaging studies revealed focal parenchymal hemorrhage and acute subdural hematoma, confirming a microaneurysm formed on the postoperative transosseous vascular network as the source of bleeding. Conservative management was performed, and no hemorrhage recurred during the 6-month follow-up period. Interestingly, follow-up imaging revealed spontaneous occlusion of the microaneurysm. However, due to the rarity of this presentation, the efficacy of conservative treatment remains unclear. Further research on similar cases is warranted.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to conditions of ethical approval but are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank a skilled Neuroradiologist in our institution, Dr. Jun Oyama, for retrospectively pointing out the possible formation of microaneurysm.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Kazuki Kondo, Shoko Hara, Azumi Kaneoka, Motoki Inaji, Yoji Tanaka, Tadashi Nariai & Taketoshi Maehara

Authors
  1. Kazuki Kondo
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  2. Shoko Hara
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  3. Azumi Kaneoka
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  4. Motoki Inaji
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  5. Yoji Tanaka
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  6. Tadashi Nariai
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  7. Taketoshi Maehara
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Contributions

Kazuki Kondo contributed to the acquisition and drafting of the article. Shoko Hara contributed to the conception, design, acquisition, and interpretation of data. Azumi Kaneoka contributed to the acquisition and interpretation of the data. Motoki Inaji, Yoji Tanaka and Tadashi Nariai contributed to the interpretation of data. Taketoshi Maehara supervised the study. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Shoko Hara.

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Ethics approval

The observational study of the long-term prognosis of moyamoya disease patients (M2000-1331) and the genetic study (G2016-009) were approved by the Ethics Review Committee of Tokyo Medical and Dental University.

Consent to publish

The patient had consented to the submission of the case report to this journal. The genetic evaluation was performed for the research with ethical approval and with written informed consent of the patient.

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The authors have no competing interests to declare that are relevant to the content of this article.

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Kondo, K., Hara, S., Kaneoka, A. et al. Spontaneous occlusion of ruptured microaneurysm formed on postoperative transosseous anastomosis after indirect revascularization in a patient with moyamoya disease. Acta Neurochir 166, 206 (2024). https://doi.org/10.1007/s00701-024-06102-1

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  • DOI: https://doi.org/10.1007/s00701-024-06102-1

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