title: Intracranial Aneurysms Associated with Moyamoya Disease in Children: Clinical Features and Long-Term Surgical Outcome.
abstract: BACKGROUND
  Moyamoya disease (MMD) in children was rarely associated with intracranial aneurysms. The purpose of this study was to report the clinical characteristics and long-term surgical outcomes of pediatric intracranial aneurysms accompanied with MMD.
  
  
  METHODS
  Between October 2002 and October 2013, our department treated 9 pediatric MMD patients (aged ≤17 years) with intracranial aneurysms. Clinical and angiographic features, treatment selection, as well as follow-up information were obtained and analyzed. The efficacy of vascularization and the changes of intracranial aneurysms were evaluated with digital subtraction angiography (DSA). We also collected 7 previously published reports to analyze the characteristics of this rare condition.
  
  
  RESULTS
  In our series of 9 patients, 7 were male. The mean age was 11 ± 3.4 years (range 5-16). Seven patients presented with intracranial hemorrhage as the initial manifestation, while 2 patients suffered transient ischemic attacks. The most common aneurysm location was the posterior choroidal artery (4, 44.4%). One anterior choroidal artery aneurysm was completely embolized with Onyx (ev3, Irvine, California, USA). One posterior choroidal artery aneurysm failed due to inaccessibility to the parent artery. Bilateral encephalo-duro-arterio-synangiosis (EDAS) surgery was performed for all the children. During the follow-up period of 6.4 ± 2.2 years (range 3-11), spontaneous occlusion of aneurysm was observed in 4 children, including 1 child with middle cerebral artery aneurysm, 1 with lenticulostriate artery aneurysm, and 2 with posterior choroidal artery aneurysm. Good or fair vascularization was observed in all the 9 children with DSA follow-up. No patients suffered intracranial hemorrhage during the follow-up period.
  
  
  CONCLUSIONS
  The long-term survey showed EDAS surgery could effectively increase the cerebral blood flow and maintain good outcomes in children, which may further result in the disappearance of the intracranial aneurysms and decrease the incidence of recurrent hemorrhage.
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Department of Neurosurgery, 307 Hospital, PLA, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Xian-Li
authors.initials: XL
authors.lastname: Lv
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, 307 Hospital, PLA, Beijing, PR China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Hui-Jian
authors.initials: HJ
authors.lastname: Ge
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Heng-Wei
authors.initials: HW
authors.lastname: Jin
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Xin
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China.
authors.forename: Ming
authors.initials: M
authors.lastname: Lv
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, PR China. Electronic address: liyouxiang@263.net.
authors.forename: You-Xiang
authors.initials: YX
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, 307 Hospital, PLA, Beijing, PR China. Electronic address: duanlian307@sina.com.
authors.forename: Lian
authors.initials: L
authors.lastname: Duan
mesh_terms: D000293:Adolescent; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Aneurysm; Intracranial; Long-term; Pediatric; Surgical outcome