Treatment strategies and prognostic analysis of moyamoya disease associated with single intracranial aneurysm

Abstract

Background and Objective

Moyamoya disease (MMD) with intracranial aneurysm is relatively rare and its treatment is more challenging. There is little agreement regarding the optimal management strategies, treatment modalities and surgical timing for these refractory lesions. This study retrospectively analyzed and summarized the clinical characteristics, treatment strategies, and outcomes of MMD with intracranial aneurysms to further elucidate these issues.

Methods

The clinical and angiographic data of 690 patients with MMD were retrospectively collected and analyzed in a single institute from July 2017 to April 2023. Among them, 60 MMD patients with single intracranial aneurysm were included in this study. All patients underwent cerebral revascularization with endovascular embolization, surgical clipping, or aneurysmectomy to eliminate intracranial aneurysms, increase cerebral blood flow, and improve long-term prognosis. In this study, intracranial aneurysms were classified as the proximal aneurysms and the distal aneurysms according to the anatomic location. The patients were divided into a one-stage operation group and a staged operation group based on the different operative procedure. The main endpoint of this study was to summarize the clinical characteristics and treatment experience, and to explore whether there were differences in clinical results between the one-stage operation group and the staged operation group, analysis the potential risk factors for postoperative complications, to further guide the clinic and establish the appropriate treatment strategies.

Results

There were significant differences in age of onset, presentation of MMD, status of aneurysm and types of hemorrhage between the proximal aneurysms group and the distal aneurysms group. The incidence of the proximal aneurysms was significantly higher than that of the distal aneurysms. Patients with distal aneurysms had a relatively younger age and a higher percentage of cerebral hemorrhage as an initial clinical presentation than patients with proximal aneurysms. The rate of procedure-related complications was significantly higher in the one-stage operation group than in the staged operation group (48.3 % vs. 22.6 %, respectively). Univariate analysis revealed that postoperative complications were significantly correlated with age, operative procedure (one-stage operation or staged operation). Multivariate analysis revealed operative procedure [OR 0.125 (0.023–0.665) p = 0.015] as independent risk factors for postoperative complications.

Conclusion

There is no consensus on the optimal treatment strategies and surgical timing for the management of MMD with intracranial aneurysms. In this regard, our results demonstrate that the current treatment strategy of interventional embolization or craniotomy with aneurysm clipping or excision followed by staged cerebral revascularization may provide a benefit for MMD patients with intracranial aneurysms.