PMC7388173_01
Initial computerized tomographic images and cerebral angiographic images of case 1.. A: Computerized tomography (CT) revealed severe intraventricular hemorrhage. B: CT angiography showed a round 5 mm aneurysm in the right inferior horn of the lateral ventricle (white arrow).. C: Right carotid cerebral angiography revealed occlusion of the terminal portion of the right internal carotid artery with extensive moyamoya vessels, and an aneurysm in the distal portion of the anterior choroidal artery (white arrow). D: Right carotid cerebral angiography, lateral view, shows an aneurysm (white arrow).
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Cerebral angiography (CAG) revealed occlusion of the terminal portion of the right internal carotid artery (ICA) with extensive moyamoya vessels, and demonstrated the characteristic appearance of MMD as well as an aneurysm in the distal portion of the anterior choroidal artery (AchA) (Fig. 1).
Operative views and postoperative computerized tomographic images of case 1.. A: A small corticotomy was made in the right middle temporal gyrus. B: Intraoperative findings revealed an aneurysm in the inferior horn of the right lateral ventricle (white arrow). C: Computerized tomography (CT) after the direct surgical procedure confirmed removal of the aneurysm. D: CT scan obtained in the immediate post-treatment period after endoscopic removal of the intraventricular hemorrhage.
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After treating the IVA, we performed endoscopic surgery to remove the residual IVH in the left lateral ventricle, allowing nearly all of the IVH to be removed (Fig. 2).
PMC7388173_02
Initial computerized tomographic images and cerebral angiographic images of case 2.. A: Computerized tomography (CT) showed acute hydrocephalus. B: CT revealed severe cast-type intraventricular hemorrhage. C: CT angiography showed an aneurysm in the right body of the lateral ventricle (white arrow). D: Right carotid cerebral angiography revealed occlusion of the terminal portion of the right internal carotid artery with extensive moyamoya vessels, and an aneurysm in the distal portion of the posterior choroidal artery (white arrow).
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The characteristic appearance of MMD was noted, and an aneurysm in the posterior choroidal artery (PchA) was revealed, as well as blowout of contrast agent into the ventricle on the moving image (Fig. 3).
Postoperative computerized topographic images of case 2.. Left: Computerized tomography (CT) scan obtained immediately after transcatheter arterial embolization using Histoacryl (n-butyl-2-cyanoacrylate). Right: CT scan obtained immediately after endoscopic removal of the intraventricular hemorrhage.
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After treating the IVA, we performed endoscopic surgery to eliminate the residual IVH, nearly all of which was removed (Fig. 4).