title: Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease.
abstract: We report a woman who presented with an intraparenchymal hemorrhage. Her cerebral angiogram showed a middle cerebral artery (MCA) M1 occlusion with multiple collaterals supplying the distal MCA territory, compatible with moyamoya disease. Also, an associated 8 mm dysplastic distal aneurysm fed by a left-sided P2 perforator was seen, collateral from the posterior cerebral artery. The aneurysm was successfully occluded with Onyx (ev3 Endovascular, Plymouth, MN, USA) embolization. The woman had an uneventful postoperative course. Aneurysm formation in patients with moyamoya disease represents a major hemorrhagic risk. Several treatment strategies exist including endovascular and surgical approaches. Patients with moyamoya disease who present with aneurysmal intracerebral hemorrhage should be treated to prevent rebleeding. Onyx embolization can be an effective treatment of aneurysms that are associated with moyamoya disease and would otherwise be difficult to treat surgically.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience, Third Floor, 901 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience, Third Floor, 901 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience, Third Floor, 901 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience, Third Floor, 901 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience, Third Floor, 901 Walnut Street, Philadelphia, PA 19107, USA. Electronic address: pascal.jabbour@jefferson.edu.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011145:Polyvinyls / Q000008:administration & dosage*; D013635:Tantalum / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Aneurysm; Endovascular treatment; Moyamoya; Onyx