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Cerebral Arteriovenous Malformation Associated with Moyamoya Disease

  • Noh, Jung-Hoon (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yeon, Je Young (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Jae-Han (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shin, Hyung Jin (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2014.03.31
  • Accepted : 2014.09.29
  • Published : 2014.10.28

Abstract

The coexistence of moyamoya disease (MMD) with an arteriovenous malformation (AVM) is exceedingly rare. We report two cases of AVM associated with MMD. The first case was an incidental AVM diagnosed simultaneously with MMD. This AVM was managed expectantly after encephalo-duro-arterio-synangiosis (EDAS) as the main feeders stemmed from the internal carotid artery, which we believed would be obliterated with the progression of MMD. However, the AVM persisted with replacement of the internal carotid artery feeders by new external carotid artery feeders from the EDAS site. The AVM was eventually treated with gamma knife radiosurgery considering an increasing steal effect. The second case was a de novo AVM case. The patient was initially diagnosed with MMD, and acquired an AVM eight years later that was slowly fed by the reconstituted anterior cerebral artery. Because the patient remained asymptomatic, the AVM is currently being closely followed for more than 2 years without further surgical intervention. Possible differences in the pathogenesis and the radiologic presentation of these AVMs are discussed with a literature review. No solid consensus exists on the optimal treatment of MMD-associated AVMs. Gamma knife radiosurgery appears to be an effective treatment option for an incidental AVM. However, a de novo AVM may be managed expectantly considering the possible risks of damaging established collaterals, low flow characteristics, and probably low risks of rupture.

Keywords

References

  1. Akiyama K, Minakawa T, Tsuji Y, Isayama K : Arteriovenous malformation associated with moyamoya disease : case report. Surg Neurol 41 : 468-471, 1994 https://doi.org/10.1016/0090-3019(94)90009-4
  2. Chen Z, Zhu G, Feng H, Lin J, Wu N : Giant arteriovenous malformation associated with unilateral moyamoya disease in a child : case report. Surg Neurol 67 : 89-92; discussion 93, 2007 https://doi.org/10.1016/j.surneu.2006.01.026
  3. Fujimura M, Kimura N, Ezura M, Niizuma K, Uenohara H, Tominaga T : Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease. J Neurosurg Pediatr 13 : 647-649, 2014 https://doi.org/10.3171/2014.3.PEDS13610
  4. Fukui M : Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis ('moyamoya' disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Clin Neurol Neurosurg 99 Suppl 2 : S238-S240, 1997
  5. Fuse T, Takagi T, Fukushima T, Hashimoto N, Yamada K : Arteriovenous malformation associated with moyamoya disease. Childs Nerv Syst 12 : 404-408, 1996 https://doi.org/10.1007/BF00395095
  6. Halatsch ME, Rustenbeck HH, Jansen J : Progression of arteriovenous malformation in moyamoya syndrome. Acta Neurochir (Wien) 139 : 82-85, 1997 https://doi.org/10.1007/BF01850873
  7. Kayama T, Suzuki S, Sakurai Y, Nagayama T, Ogawa A, Yoshimoto T : A case of moyamoya disease accompanied by an arteriovenous malformation. Neurosurgery 18 : 465-468, 1986 https://doi.org/10.1227/00006123-198604000-00014
  8. Lichtor T, Mullan S : Arteriovenous malformation in moyamoya syndrome. Report of three cases. J Neurosurg 67 : 603-608, 1987 https://doi.org/10.3171/jns.1987.67.4.0603
  9. Mawad ME, Hilal SK, Michelsen WJ, Stein B, Ganti SR : Occlusive vascular disease associated with cerebral arteriovenous malformations. Radiology 153 : 401-408, 1984 https://doi.org/10.1148/radiology.153.2.6484172
  10. Montanera W, Marotta TR, terBrugge KG, Lasjaunias P, Willinsky R, Wallace MC : Cerebral arteriovenous malformations associated with moyamoya phenomenon. AJNR Am J Neuroradiol 11 : 1153-1156, 1990
  11. Nakashima T, Nakayama N, Furuichi M, Kokuzawa J, Murakawa T, Sakai N : Arteriovenous malformation in association with moyamoya disease. Report of two cases. Neurosurg Focus 5 : e6, 1998
  12. Nawawi O, Sinnasamy M, Ramli N : Unilateral moyamoya disease with co-existing arteriovenous malformation. Br J Radiol 79 : e12-e15, 2006 https://doi.org/10.1259/bjr/40183814
  13. Okada T, Kida Y, Kinomoto T, Sakurai T, Kobayashi T : Arteriovenous malformation associated with moyamoya disease--case report. Neurol Med Chir (Tokyo) 30 : 945-948, 1990 https://doi.org/10.2176/nmc.30.945
  14. Schmit BP, Burrows PE, Kuban K, Goumnerova L, Scott RM : Acquired cerebral arteriovenous malformation in a child with moyamoya disease. Case report. J Neurosurg 84 : 677-680, 1996 https://doi.org/10.3171/jns.1996.84.4.0677
  15. Seol HJ, Kim DG, Oh CW, Han DH : Radiosurgical treatment of a cerebral arteriovenous malformation in a patient with moyamoya disease : case report. Neurosurgery 51 : 478-481; discussion 481-482, 2002 https://doi.org/10.1227/00006123-200208000-00031
  16. Somasundaram S, Thamburaj K, Burathoki S, Gupta AK : Moyamoya disease with cerebral arteriovenous malformation presenting as primary subarachnoid hemorrhage. J Neuroimaging 17 : 251-254, 2007 https://doi.org/10.1111/j.1552-6569.2007.00096.x

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