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A 20-year-old female with moyamoya disease presented with acute intraventricular hemorrhage. Cerebral angiography demonstrated that the anterior choroidal artery (AChA) was responsible for the bleeding, but the precise point of rupture was unpredictable, because multiple angiographic weak spots were found on the artery. As direct targeting of the rupture point was unfeasible, we performed encephalo-duro-arterio-synangiosis to decrease the hemodynamic overload on the AChA. This revascularization procedure alone successfully induced the regression of all weak points. In this report, we demonstrated that, when direct targeting of weak points was not feasible, a revascularization procedure was an acceptable alternative.

Regression of moyamoya-associated weak spots on the distal anterior choroidal artery following surgical revascularization