Intracerebral hemorrhage after prophylactic revascularization in a patient with adult moyamoya disease.

BACKGROUND

The effect of revascularization surgery for a patient with moyamoya disease remains controversial.

CASE DESCRIPTION: A 60-year-old man presented with bleeding from asymptomatic moyamoya vessels 10 years after prophylactic revascularization surgery. Cerebral angiography 10 years after the surgery demonstrated that the bilateral direct anastomoses remained effective and a small aneurysm persisted in the anterior choroidal artery. The territories of perfusion through the anastomoses and the size of the aneurysm remained unchanged compared with the angiograms performed 10 years ago.

CONCLUSIONS

Direct revascularization surgery may not always resolve microaneurysms in the moyamoya vessels and prevent rebleeding in patients with hemorrhagic moyamoya disease or bleeding in the nonaffected side.