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The authors reviewed five cases of Moyamoya disease associated with intracranial aneurysms, among 60 cases of Moyamoya disease experienced during the past 17 years. The initial symptom was hemorrhagic ictus in all cases. CT scans revealed subarachnoid homerrhage in two cases and intracerebral hemorrhage in three cases. Angiography showed an aneurysm at the basilar tip in one case, at the C 2 portion in three cases and at the distal portion of the anterior choroidal artery in one case. In regard to treatment, we operated two patients in the early stage, treated two patients conservatively and planned a delayed operation for aneurysmal clipping on one case. In the last case, the patient expired from rerupture of the aneurysm prior to the operation. The following points are important in the surgical treatment of Moyamoya disease with intracranial aneurysms manifesting intracranial hemorrhage. 1) In case of rupture of an aneurysm located on the circle of Willis, a clipping operation should be performed to prevent rerupture. 2) In case of a peripheral aneurysm, follow-up angiography is necessary. When the aneurysm disappears, a reconstructive operation should be performed to prevent rebleeding from the Moyamoya vessels.

Five Cases of Moyamoya Disease with Intracranial Aneurysms