{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:02:55Z","timestamp":1780120975902,"version":"3.54.0"},"reference-count":27,"publisher":"IMR Press","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100022963","name":"Key Research and Development Program of Zhejiang Province","doi-asserted-by":"crossref","award":["2024C03281(SD2)"],"award-info":[{"award-number":["2024C03281(SD2)"]}],"id":[{"id":"10.13039\/100022963","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Neurol."],"abstract":"<jats:p>Introduction: There is no consensus on the optimal management of intracranial aneurysms in patients with moyamoya disease. Here, we report a case of a patient in the subacute hemorrhagic stage of moyamoya disease with a presumed pseudoaneurysm detected on interval imaging, who was treated with aneurysm resection combined with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass. This report illustrates a feasible individualized surgical approach for similar cases. Case Report: A 27-year-old male without a prior history of cerebrovascular disease was admitted for a right temporal intracerebral hemorrhage following external ventricular drainage. Initial computed tomography angiography (CTA) at admission showed no aneurysm. One week later, follow-up CTA revealed a newly developed 10 \u00d7 9 mm aneurysm in the right MCA region. Subsequent digital subtraction angiography (DSA) demonstrated occlusion of the right MCA M1 segment with the development of characteristic moyamoya collateral networks. The patient underwent microsurgical resection of the aneurysmal lesion, combined with a right STA-MCA bypass. Postoperative imaging demonstrated complete obliteration of the aneurysm, patency of the bypass, and a reduction in moyamoya collateral vessels. Histopathological examination revealed a red blood cell clot surrounded by fibrous connective tissue without definitive evidence of a preserved arterial wall, consistent with a presumed pseudoaneurysm. The patient recovered well, with improved neurological function on follow-up imaging. Conclusions: In patients with moyamoya disease, a peripheral aneurysmal lesion may become detectable on interval imaging after an initially negative CTA and may represent an unstable hemorrhage-related vascular lesion. In carefully selected cases, lesion resection combined with STA-MCA bypass during the subacute phase may be a feasible individualized treatment strategy, particularly when direct lesion treatment and hemodynamic revascularization are both required. However, longer clinical and imaging follow-up is needed before any firm conclusions can be drawn regarding outcome improvement, or prevention of rebleeding.<\/jats:p>","DOI":"10.31083\/rn50491","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T05:34:23Z","timestamp":1780119263000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical Treatment of an Aneurysm in the Subacute Stage of Hemorrhagic Moyamoya Disease: Aneurysm Resection Combined With STA-MCA Bypass: A Case Report"],"prefix":"10.31083","volume":"81","author":[{"given":"Yuezhu","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiancong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8309-5372","authenticated-orcid":true,"given":"Jinghui","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengyu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, 315010 Ningbo, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives. The Lancet. Neurology. 2008; 7: 1056\u20131066.","DOI":"10.1016\/S1474-4422(08)70240-0"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Kim JH, Kwon TH, Kim JH, Chong K, Yoon W. Intracranial Aneurysms in Adult Moyamoya Disease. World Neurosurgery. 2018; 109: e175\u2013e182.","DOI":"10.1016\/j.wneu.2017.09.127"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Sumi T, Kawamoto S, Fukaya S, Ueki K, Kim P. Middle Cerebral Artery Aneurysm Associated with Moyamoya Disease. World Neurosurgery. 2020; 140: 233\u2013236.","DOI":"10.1016\/j.wneu.2020.05.111"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Yu JL, Wang HL, Xu K, Li Y, Luo Q. Endovascular treatment of intracranial aneurysms associated with moyamoya disease or moyamoya syndrome. Interventional Neuroradiology. 2010; 16: 240\u2013248.","DOI":"10.1177\/159101991001600302"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ali MJ, Bendok BR, Getch CC, Gottardi-Littell NR, Mindea S, Batjer HH. Surgical management of a ruptured posterior choroidal intraventricular aneurysm associated with moyamoya disease using frameless stereotaxy: case report and review of the literature. Neurosurgery. 2004; 54: 1019\u20131024.","DOI":"10.1227\/01.neu.0000115676.99378.9c"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Acker G, Fekonja L, Vajkoczy P. Surgical Management of Moyamoya Disease. Stroke. 2018; 49: 476\u2013482.","DOI":"10.1161\/STROKEAHA.117.018563"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Luo Y, Guo C, Wu S, Sun X. Treatment Options for Patients With Moyamoya Disease: A Retrospective Cohort Study. Revista de Neurolog\u00eda. 2025; 80: 45032.","DOI":"10.31083\/RN45032"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Larson AS, Rinaldo L, Brinjikji W, Lanzino G. Location-based treatment of intracranial aneurysms in moyamoya disease: a systematic review and descriptive analysis. Neurosurgical Review. 2021; 44: 1127\u20131139.","DOI":"10.1007\/s10143-020-01307-1"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Kawaguchi S, Sakaki T, Morimoto T, Kakizaki T, Kamada K. Characteristics of intracranial aneurysms associated with moyamoya disease. A review of 111 cases. Acta Neurochirurgica. 1996; 138: 1287\u20131294.","DOI":"10.1007\/BF01411057"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Ding W, Zhao Y, Liu L, Wang P, Qiu W, Ren H, et al. Moyamoya disease with distal anterior choroidal artery aneurysm resected via transcallosal approach: A case report and review. Medicine. 2023; 102: e33973.","DOI":"10.1097\/MD.0000000000033973"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Kanamori F, Takasu S, Ota S, Seki Y. Prevention of the Rerupture of Collateral Artery Aneurysms on the Ventricular Wall by Early Surgical Revascularization in Moyamoya Disease: Report of Two Cases and Review of the Literature. World Neurosurgery. 2018; 109: 393\u2013397.","DOI":"10.1016\/j.wneu.2017.10.059"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Lee GY, Cho BK, Hwang SH, Roh H, Kim JH. Hydration-induced rapid growth and regression after indirect revascularization of an anterior choroidal artery aneurysm associated with Moyamoya disease: A case report. Journal of Cerebrovascular and Endovascular Neurosurgery. 2023; 25: 75\u201380.","DOI":"10.7461\/jcen.2022.E2022.02.002"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Otawara Y, Ogasawara K, Seki K, Kibe M, Kubo Y, Ogawa A. Intracerebral hemorrhage after prophylactic revascularization in a patient with adult moyamoya disease. Surgical Neurology. 2007; 68: 335\u2013337.","DOI":"10.1016\/j.surneu.2006.10.061"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Tsuboki S, Mitsutake T, Kadooka K, Tanaka M. Transarterial Embolization With N-Butyl-2-Cyanoacrylate for Rapidly Enlarging Distal Anterior Choroidal Artery Aneurysm Associated With Moyamoya Disease: A Case Report. Cureus. 2024; 16: e65340.","DOI":"10.7759\/cureus.65340"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Yamada H, Saga I, Kojima A, Horiguchi T. Short-Term Spontaneous Resolution of Ruptured Peripheral Aneurysm in Moyamoya Disease. World Neurosurgery. 2019; 126: 247\u2013251.","DOI":"10.1016\/j.wneu.2019.02.193"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Yoon JT, Lee KM, Ryu J, Park JI. Rapidly growing distal choroidal artery aneurysm re-rupture following revascularization for hemorrhagic Moyamoya disease: A case report. Clinical Case Reports. 2024; 12: e8605.","DOI":"10.1002\/ccr3.8605"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Yuasa H, Tokito S, Izumi K, Hirabayashi K. Cerebrovascular moyamoya disease associated with an intracranial pseudoaneurysm. Case report. Journal of Neurosurgery. 1982; 56: 131\u2013134.","DOI":"10.3171\/jns.1982.56.1.0131"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Borota L, Marinkovic S, Bajic R, Kovacevic M. Intracranial aneurysms associated with moyamoya disease. Neurologia Medico-Chirurgica. 1996; 36: 860\u2013864.","DOI":"10.2176\/nmc.36.860"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Zheng Y, Lu Z, Shen J, Xu F. Intracranial Pseudoaneurysms: Evaluation and Management. Frontiers in Neurology. 2020; 11: 582.","DOI":"10.3389\/fneur.2020.00582"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Yang RM, Hao FB, Zhao B, Zhang Q, Yu D, Zou ZX, et al. Natural course and risk factors of moyamoya disease with unruptured intracranial aneurysm. Frontiers in Neurology. 2023; 14: 1115909.","DOI":"10.3389\/fneur.2023.1115909"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Larson A, Rinaldo L, Brinjikji W, Meyer F, Lanzino G. Intracranial Aneurysms in White Patients with Moyamoya Disease: A U.S. Single-Center Case Series and Review. World Neurosurgery. 2020; 138: e749\u2013e758.","DOI":"10.1016\/j.wneu.2020.03.072"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Ge P, Ye X, Zhang Q, Liu X, Deng X, Zhao M, et al. Clinical features, surgical treatment, and outcome of intracranial aneurysms associated with moyamoya disease. Journal of Clinical Neuroscience. 2020; 80: 274\u2013279.","DOI":"10.1016\/j.jocn.2020.09.006"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Ni W, Xu F, Xu B, Liao Y, Gu Y, Song D. Disappearance of aneurysms associated with moyamoya disease after STA-MCA anastomosis with encephaloduro myosynangiosis. Journal of Clinical Neuroscience. 2012; 19: 485\u2013487.","DOI":"10.1016\/j.jocn.2011.05.036"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Rhim JK, Cho YD, Jeon JP, Yoo DH, Cho WS, Kang HS, et al. Ruptured Aneurysms of Collateral Vessels in Adult Onset Moyamoya Disease with Hemorrhagic Presentation. Clinical Neuroradiology. 2018; 28: 191\u2013199.","DOI":"10.1007\/s00062-016-0554-8"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Zhao X, Wang X, Wang M, Meng Q, Wang C. Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease. British Journal of Neurosurgery. 2021; 35: 209\u2013215.","DOI":"10.1080\/02688697.2020.1781058"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Ni W, Jiang H, Xu B, Lei Y, Yang H, Su J, et al. Treatment of aneurysms in patients with moyamoya disease: a 10-year single-center experience. Journal of Neurosurgery. 2018; 128: 1813\u20131822.","DOI":"10.3171\/2017.3.JNS162290"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Kawaguchi S, Sakaki T, Kakizaki T, Kamada K, Shimomura T, Iwanaga H. Clinical features of the haemorrhage type moyamoya disease based on 31 cases. 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