title: Surgical management of a ruptured posterior choroidal intraventricular aneurysm associated with moyamoya disease using frameless stereotaxy: case report and review of the literature.
abstract: OBJECTIVE
  Prevention of rebleeding is the most important aspect of the management of hemorrhagic moyamoya disease, because rebleeding causes significant morbidity and mortality.
  
  
  METHODS
  A 26-year-old male patient with a history of moyamoya disease since the age of 3 years and multiple strokes was in a semicomatose state at presentation. He was found to have intraventricular and periventricular hemorrhages abutting the atrium of the right ventricle. His hospital course was complicated by a second hemorrhage. Both bleeding events were believed to be secondary to a ruptured right lateral posterior choroidal aneurysm.
  
  
  METHODS
  The aneurysm was excised and revealed histopathology consistent with a true saccular aneurysm. Frameless stereotactic guidance was used during surgery to minimize damage to collateral vessels and to shorten the surgical corridor.
  
  
  CONCLUSIONS
  The management of hemorrhagic moyamoya disease should be modified based on the source of hemorrhage and its relation to a specifically located aneurysm. In the case of aneurysms arising from the choroidal artery, the general belief is that most of these represent pseudoaneurysms and have a tendency to regress spontaneously. Because of the rebleeding risk, we recommend early intervention in treating ruptured intracranial aneurysms using the least invasive surgical techniques.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 233 East Erie Street, Chicago, IL 60611, USA.
authors.forename: M Jafer
authors.initials: MJ
authors.lastname: Ali
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Getch
authors.forename: Numa R
authors.initials: NR
authors.lastname: Gottardi-Littell
authors.forename: Stefan
authors.initials: S
authors.lastname: Mindea
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D002831:Choroid Plexus / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009460:Neurologic Examination; D012008:Recurrence; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed