{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:36:43Z","timestamp":1769726203138,"version":"3.49.0"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,10,20]]},"abstract":"\n BACKGROUND<\/jats:title>\n Moyamoya disease (MMD) is a progressive cerebrovascular disorder characterized by stenosis of the distal internal carotid arteries and development of collateral vessels. While surgical revascularization through direct superficial temporal artery\u2013to\u2013middle cerebral artery (MCA) bypass is the primary treatment for adults with MMD, rare but potentially fatal hemorrhagic complications can occur due to hemodynamic changes.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 34-year-old male with MMD who had previously undergone combined direct and indirect bypass surgery developed a massive intracerebral hemorrhage 2.5 months postoperatively. Imaging revealed an aneurysm at the anastomosis site as the bleeding source. Emergency surgery was performed to evacuate the hematoma and clip the aneurysm while preserving the bypass. The aneurysm originated from the MCA wall opposite to the anastomotic site, suggesting a hemodynamic etiology. Postoperative angiography confirmed complete clipping with preserved anastomotic patency. The patient was discharged with severe left-sided hemiparesis but without speech or cognitive impairment.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case represents the shortest documented interval between combined bypass surgery and a ruptured de novo anastomotic aneurysm. Genetic predisposition, inflammatory processes, and hemodynamic alterations likely contribute to aneurysm formation. Standardized postoperative surveillance and individualized management strategies are essential to mitigate these risks.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25429<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25429","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:23:25Z","timestamp":1760955805000},"source":"Crossref","is-referenced-by-count":0,"title":["A ruptured de novo anastomotic aneurysm shortly after superficial temporal artery\u2013to\u2013middle cerebral artery bypass surgery in a patient with moyamoya disease: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0229-0139","authenticated-orcid":true,"given":"Konstantinos","family":"Lintas","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Dortmund Hospital, Dortmund, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunichiro","family":"Kuramitsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2697-6613","authenticated-orcid":true,"given":"Kaoru","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Matsuno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0909-2353","authenticated-orcid":true,"given":"Yoshiki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Asanuma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Maesawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"World Neurosurg","first-page":"e1032","article-title":"Long-term outcomes after combined revascularization surgery in adult hemorrhagic moyamoya disease","volume":"116","author":"Jiang","year":"2018","unstructured":"Jiang HYang HNi WLong-term outcomes after combined revascularization surgery in adult hemorrhagic moyamoya disease. World Neurosurg. 2018;116:e1032-e1041."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"909","article-title":"Late (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease","volume":"134","author":"Kuroda","year":"2021","unstructured":"Kuroda SNakayama NYamamoto SLate (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease. J Neurosurg. 2021;134(3):909-916."},{"key":"bib3","series-title":"Clin Neurol Neurosurg","first-page":"107060","article-title":"Understanding the genetics of intracranial aneurysms: a primer","volume":"212","author":"Laurent","year":"2022","unstructured":"Laurent DSmall CLucke-Wold BUnderstanding the genetics of intracranial aneurysms: a primer. Clin Neurol Neurosurg. 2022;212:107060."},{"issue":"11","key":"bib4","series-title":"CNS Neurol Disord Drug Targets","first-page":"1345","article-title":"Emerging treatments for subarachnoid hemorrhage","volume":"23","author":"Findlay","year":"2024","unstructured":"Findlay MCKundu MNelson JREmerging treatments for subarachnoid hemorrhage. CNS Neurol Disord Drug Targets. 2024;23(11):1345-1356."},{"issue":"1","key":"bib5","series-title":"Biomedicines","article-title":"Exploring RNF213 in ischemic stroke and moyamoya disease: from cellular models to clinical insights","volume":"13","author":"Tan","year":"2024","unstructured":"Tan BYQKok CHPNg MBJExploring RNF213 in ischemic stroke and moyamoya disease: from cellular models to clinical insights. Biomedicines. 2024;13(1):17."},{"issue":"11","key":"bib6","series-title":"Brain","first-page":"4674","article-title":"RNF213 loss-of-function promotes pathological angiogenesis in moyamoya disease via the Hippo pathway","volume":"146","author":"Ye","year":"2023","unstructured":"Ye FNiu XLiang FRNF213 loss-of-function promotes pathological angiogenesis in moyamoya disease via the Hippo pathway. Brain. 2023;146(11):4674-4689."},{"key":"bib7","series-title":"Front Neurol","first-page":"661578","article-title":"Pathophysiology of vascular stenosis and remodeling in moyamoya disease","volume":"12","author":"Fox","year":"2021","unstructured":"Fox BMDorschel KBLawton MTWanebo JE.Pathophysiology of vascular stenosis and remodeling in moyamoya disease. 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Neurol Med Chir (Tokyo). 2010;50(11):1012-1014."},{"issue":"5","key":"bib16","series-title":"Jpn J Neurosurg (Tokyo)","first-page":"394","article-title":"An operated case of aneurysm formation and growth at the site of superficial temporal artery-middle cerebral artery anastomosis","volume":"22","author":"Takazawa","year":"2013","unstructured":"Takazawa HKawaguchi TNarisawa AAn operated case of aneurysm formation and growth at the site of superficial temporal artery-middle cerebral artery anastomosis. 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Acta Neurochir (Wien). 2010;152(6):1069-1073."},{"issue":"3","key":"bib23","series-title":"Neurosurg Rev","first-page":"517","article-title":"Navigation-guided clipping of a de novo aneurysm associated with superficial temporal artery-middle cerebral artery bypass combined with indirect pial synangiosis in a patient with moyamoya disease","volume":"40","author":"Aburakawa","year":"2017","unstructured":"Aburakawa DFujimura MNiizuma KSakata HEndo HTominaga T.Navigation-guided clipping of a de novo aneurysm associated with superficial temporal artery-middle cerebral artery bypass combined with indirect pial synangiosis in a patient with moyamoya disease. Neurosurg Rev. 2017;40(3):517-521."},{"issue":"20","key":"bib24","series-title":"J Neurosurg Case Lessons","first-page":"CASE23529","article-title":"Aneurysm appearing at the anastomosis site 11 years after superficial temporal artery-middle cerebral artery bypass surgery: moyamoya disease with a rapidly growing aneurysm. 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J Neurosurg. 2021;134(3):909-916."},{"key":"bib3","series-title":"Clin Neurol Neurosurg","first-page":"107060","article-title":"Understanding the genetics of intracranial aneurysms: a primer","volume":"212","author":"Laurent","year":"2022","unstructured":"Laurent DSmall CLucke-Wold BUnderstanding the genetics of intracranial aneurysms: a primer. Clin Neurol Neurosurg. 2022;212:107060."},{"issue":"11","key":"bib4","series-title":"CNS Neurol Disord Drug Targets","first-page":"1345","article-title":"Emerging treatments for subarachnoid hemorrhage","volume":"23","author":"Findlay","year":"2024","unstructured":"Findlay MCKundu MNelson JREmerging treatments for subarachnoid hemorrhage. CNS Neurol Disord Drug Targets. 2024;23(11):1345-1356."},{"issue":"1","key":"bib5","series-title":"Biomedicines","article-title":"Exploring RNF213 in ischemic stroke and moyamoya disease: from cellular models to clinical insights","volume":"13","author":"Tan","year":"2024","unstructured":"Tan BYQKok CHPNg MBJExploring RNF213 in ischemic stroke and moyamoya disease: from cellular models to clinical insights. Biomedicines. 2024;13(1):17."},{"issue":"11","key":"bib6","series-title":"Brain","first-page":"4674","article-title":"RNF213 loss-of-function promotes pathological angiogenesis in moyamoya disease via the Hippo pathway","volume":"146","author":"Ye","year":"2023","unstructured":"Ye FNiu XLiang FRNF213 loss-of-function promotes pathological angiogenesis in moyamoya disease via the Hippo pathway. 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