Surgical management of a ruptured posterior choroidal intraventricular aneurysm associated with moyamoya disease

prevention of rebleeding is the most important aspect of the management of hemorrhagic moyamoya disease because rebleeding causes significant morbidity and mortality. a 68-year-old female patient presented with intraventricular hemorrhages abutting the atrium of the right ventricle. Cerebral angiography showed internal carotid artery occlusion with moyamoya vessels on the right side and internal carotid artery stenosis with moymoya vessels on the left side. The posterior cerebral artery was enlarged on the right side, and a lateral posterior choroidal intraventricular aneurysm was identified. The aneurysm was successfully excised transcortically using a neuronavigation system to minimize damage to collateral vessels and shorten the surgical corridor. Histopathology revealed a pseudoaneurysm. Three months later, indirect revascularization at the right hemisphere was performed. the management of hemorrhagic moyamoya disease should be modified based on the source of hemorrhage. Because of the rebleeding risk, we recommend early intervention to treat ruptured intracranial aneurysms using minimally invasive surgical techniques.