Pseudoaneurysm formation or dural arteriovenous fistula formation at the middle meningeal artery following revascularization surgery in Moyamoya disease

Dongok Seo; Byul Hee Yoon; Joonho Byun; Wonhyoung Park; Jung Cheol Park; Jae Sung Ahn

doi:10.7461/jcen.2022.E2022.07.001

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자료유형: 학술저널

저자정보: Dongok Seo (Department of Neurosurgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea) Byul Hee Yoon (Department of Neurosurgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea) Joonho Byun (Department of Neurosurgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea) Wonhyoung Park (Department of Neurosurgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea) Jung Cheol Park (Department of Neurosurgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea) Jae Sung Ahn (Department of Neurosurgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea)

저널정보: 대한뇌혈관외과학회 Journal of Cerebrovascular and Endovascular Neurosurgery Journal of Cerebrovascular and Endovascular Neurosurgery Vol.25 No.1

발행연도: 2023.3

수록면: 87 - 92 (6page)

DOI: 10.7461/jcen.2022.E2022.07.001

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Moyamoya disease (MMD) is a rare progressive steno-occlusive cerebrovascular disorder. Currently, revascularization surgery is used as optimal treatment to overcome MMD. However, revascularization for MMD has reported several complications. Also, iatrogenic complications such as pseudoaneurysms formation or dural arteriovenous fistulas (dAVFs) formation—has been identified in rare cases after the surgical intervention for revascularizations.
We describe two cases. In first case, the patency of the anastomosis site was good and saccular type pseudoaneurysm formation was found at parietal branch of posterior middle meningeal artery (MMA) in transfemoral cerebral angiography (TFCA) performed on the twelfth day after surgery. We decided to treat pseudoaneurysm by endovascular embolization the next day, but the patient was shown unconsciousness and anisocoria during sleep at that day. Computed tomography showed massive subdural hemorrhage at the ipsilateral side, thus we performed decompressive craniectomy and hematoma evacuation.
In second case, the patency of the anastomosis site was good and dAVF formation at right MMA was found in TFCA performed on the sixth day after surgery. We performed endovascular obliteration of the arteriovenous fistula under local anesthesia.
Pseudoaneurysm formation or dAVF formation after revascularization surgery is an exceptional case. If patients have such complications, practioner should carefully screen the patients by implementing digital subtraction angiogram to identify anatomic features; as well as consider immediate treatment in any way, including embolization or other surgery

#Moyamoya disease #Arteriovenous fistula #Pseudoaneurysm #Revascularization

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