Clinical Features Of Moyamoya Disease With Intracranial Aneurysms And Risk Factors For Postoperative Cerebral Infarction

Objective:Moyamoya disease(MMD)is often accompanied by intracranial aneurysms,and always associated with newly formed brain infarction after surgery or endovascular therapy.The purpose of this study was to delineate the clinical features of MMD associated intracranial aneurysms and risk factors of postoperative brain infarction for MMD associated intracranial aneurysms?Methods:We retrospectively reviewed the records of patients with MMD associated aneurysms between January,2013 and January,2018.Results:A total of 17 patients with Moyamoya disease complicated with intracranial aneurysms were included in the study.There were 9 males and 8 females,with an average age of 52.5±9.0 years.The ethnicity of the patients was Han.Most of patents came from the west of Yunnan.Of 18 aneurysms,17 were located in the main trunk of cerebral vessels,of 1 was in the peripheral pericallosal artery.The average diameter of the aneurysms was 4.21 ±1.70 mm.13 of the aneurysms developed ruptured hemorrhage with subarachnoid hemorrhage,two cases with intracerebral hemorrhage that broke into the ventricles,and one with cerebral hemorrhage.Of the 17 patients,9 patients were performed with clipping aneurysms,and 4 patients developed cerebral infarction after surgery;8 patients underwent endovascular embolization and 1 patient followed by cerebral infarction.During surgery,mean intraoperative arterial pressure in patients with cerebral infarction after surgery was lower than that in non-cerebral infarction patients(P<0.0001).Patients with cerebral infarction had longer intraoperative time than non-cerebral infarction patients(P<0.05).Low postoperative mean arterial pressure(P<0.0001)and hyperglycemia(P<0.05)were associated with postoperative cerebral infarction.Conclusion:Intraoperative hypotension,long operation time,postoperative hypotension,and postoperative hyperglycemia may be related to postoperative cerebral infarction in Moyamoya disease associated with intracranial aneurysm.Therefore,for Moyamoya disease associated with aneurysm,it was reasonable to control intraoperative and postoperative blood pressure,shortens the operation time and optimizes postoperative blood glucose levels.