PROGRESSION OF ARTERIOVENOUS MALFORMATION IN MOYAMOYA SYNDROME

We report a case of moyamoya disease (MMD) associated with arterioveno us malformation (AVM). The 30-year-old female patient presented with l eft-hemispheric transient ischaemic attacks (TIAs) involving dysphasia and right-sided hemiparesis. CT-scan acid lumbar puncture showed no e vidence of intracranial haemorrhage. Cerebral angiography revealed typ ical moyamoya vessels and occlusion of multiple cerebral arteries with consecutive collateral blood supply. Moreover, a left-parietal AVM wi th a diameter of approximately 2 cm was detected. An extra-intracrania l arterial bypass (EIAB) connecting the left superficial temporal arte ry (STA) with a cortical branch of the left middle cerebral artery (MC A) was performed (STA-MCA anastomosis) and yielded subsequent resoluti on of the neurological deficit. Nine months post-operatively neurologi cal deficits similar to those of the initial presentation recurred. Re peated angiography suggested comparatively increased AVM blood flow, a nd successful extirpation of the AVM gradually re-established almost f ull functional ability. However, deterioration of the neurological con dition developed again. We herewith present the first European case of moyamoya disease associated with arteriovenous malformation and repor t the clinical course under an alternative neurosurgical treatment con sisting of STA-MCA anastomosis and delayed extirpation of the AVM.