• Mohammad Samadian, Ehsan Alavi, Mehrdad Hosseinzadeh Bakhtevari, and Omidvar Rezaei.
• Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
• World Neurosurg. 2015 Sep 1;84(3):865.e7-11.

BackgroundWe report the efficacy and safety of surgical treatment with the orbitozygomatic transsylvian approach and the rarity of accompanying subarachnoid hemorrhage, Terson syndrome, and ruptured giant basilar tip aneurysm in a patient affected by moyamoya disease with a good outcome.MethodsA 40-year-old man with a history of exertional headache from childhood and hypertension diagnosed 5 years previously was referred to us with the presenting symptom of headache. After 1 day, he developed left hemiplegia, decreased level of consciousness, and blindness in the left eye. Imaging studies revealed a subarachnoid hemorrhage and giant basilar tip aneurysm. He underwent surgical clipping of the aneurysm using the orbitozygomatic transsylvian approach.ResultsWith obvious improvement in strength and consciousness, the patient was discharged. Early diagnosis and treatment of the other possible complications of moyamoya disease were recommended.ConclusionsThe rarity and different manifestations of moyamoya disease require individualized decision making with regard to cerebrovascular complications. Individualized decision making and the cooperation of medical teams are the mainstays of treatment.Copyright © 2015 Elsevier Inc. All rights reserved.

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