Surgical Management of Giant Basilar Tip Aneurysm Associated with Moyamoya Disease: A Case Report and Literature Review

Background We report the efficacy and safety of surgical treatment with the orbitozygomatic transsylvian approach and the rarity of accompanying subarachnoid hemorrhage, Terson syndrome, and ruptured giant basilar tip aneurysm in a patient affected by moyamoya disease with a good outcome. Methods A...

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Bibliographic Details
Published in:World neurosurgery 2015-09, Vol.84 (3), p.865.e7-865.e11
Main Authors: Samadian, Mohammad, Alavi, Ehsan, Bakhtevari, Mehrdad Hosseinzadeh, Rezaei, Omidvar
Format: Article
Language:English
Subjects:
Adult
Angiography, Digital Subtraction
Blindness - etiology
Cerebral Angiography
Consciousness Disorders - etiology
Giant aneurysm
Headache
Headache - etiology
Hemiplegia
Hemiplegia - etiology
Humans
Intracranial Aneurysm - complications
Intracranial Aneurysm - surgery
Male
Moyamoya disease
Moyamoya Disease - complications
Moyamoya Disease - surgery
Neurosurgery
Neurosurgical Procedures - methods
Subarachnoid hemorrhage
Subarachnoid Hemorrhage - etiology
Subarachnoid Hemorrhage - surgery
Tomography, X-Ray Computed
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Summary:Background We report the efficacy and safety of surgical treatment with the orbitozygomatic transsylvian approach and the rarity of accompanying subarachnoid hemorrhage, Terson syndrome, and ruptured giant basilar tip aneurysm in a patient affected by moyamoya disease with a good outcome. Methods A 40-year-old man with a history of exertional headache from childhood and hypertension diagnosed 5 years previously was referred to us with the presenting symptom of headache. After 1 day, he developed left hemiplegia, decreased level of consciousness, and blindness in the left eye. Imaging studies revealed a subarachnoid hemorrhage and giant basilar tip aneurysm. He underwent surgical clipping of the aneurysm using the orbitozygomatic transsylvian approach. Results With obvious improvement in strength and consciousness, the patient was discharged. Early diagnosis and treatment of the other possible complications of moyamoya disease were recommended. Conclusions The rarity and different manifestations of moyamoya disease require individualized decision making with regard to cerebrovascular complications. Individualized decision making and the cooperation of medical teams are the mainstays of treatment.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2015.03.059