Treatment of Moyamoya Disease and Unruptured Intracranial Aneurysm in Floating-Harbor Syndrome– A case report

Abstract Background This is the first report of the successful treatment of moyamoya disease (MMD) and an unruptured intracranial aneurysm in a patient with Floating-Harbor Syndrome (FHS). Case Description A 35 year-old, phenotypically syndromic woman presented with signs and symptoms consistent with ischemic stroke. MRI and catheter angiography confirmed diagnosis of moyamoya and a 6 mm basilar apex artery aneurysm (BAA). She underwent right sided craniotomy for direct and indirect revascularization by means of superficial temporal artery-middle cerebral artery (STA-MCA) bypass and encephalo-duro-arterio-synangiosis (EDAS). Three months later, she underwent stent-assisted coiling of the BAA. At 9 months, the patient remains without her pre-operative neurologic deficits. Interval catheter angiography confirms revascularization of her right hemisphere and obliteration of her BAA. Conclusion s: We present the first case of diagnosis and treatment of moyamoya disease and BAA in a patient with Floating-Harbor Syndrome. Due to a paucity of literature on this rare disorder, there has not been an associated link between FHS and cerebrovascular disease. Our report and literature review suggest that these patients may be prone to cerebrovascular disorders and should be followed closely with neurovascular imaging.