We report a surgical case of a ruptured basilar tip aneurysm associated with unilateral moyamoya disease in an acute stage. A 73-year-old man, suffering from a severe headache and vomiting, was transferred to our hospital with a level of consciousness of Grade 2 of Hunt & Kosnik. CT demonstrated high-density areas in bilateral ventricles and subarachnoid space. Angiography revealed a basilar tip aneurysm associated with right unilateral moyamoya disease. No remarkble decrease of CBF was demonstrated on preoperative SPECT. On Day 2, neck clipping of the aneurysm was successfully performed with left pterional approach from the opposite side to moyamoya vessels. On Day 21, hemispheric CBF was preserved at 36.1ml/100g/min on the right and at 36.9ml/100g/min on the left, and Diamox response did not decrease very much.
We discuss stages and approaches of surgical treatment for a basilar aneurysm associated with moyamoya disease by means of CBF measurement using SPECT with a review of the literature.