Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease

Introduction: Revascularization surgery for adult moyamoya disease (MMD) with ischemic presentation changes cognitive function and prevents further cerebral ischemic events. Most studies, however, repeated neuropsychological evaluation within 1 year after surgery. Our previous prospective cohort stu...

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Autores principales:	Shun Uchida, Yoshitaka Kubo, Daisuke Oomori, Masahiro Yabuki, Kei Kitakami, Shunrou Fujiwara, Kenji Yoshida, Masakazu Kobayashi, Kazunori Terasaki, Kuniaki Ogasawara
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/a53143f9f9b44f7fad925ff68bddb475
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spelling	oai:doaj.org-article:a53143f9f9b44f7fad925ff68bddb4752021-12-02T12:40:23ZLong-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease1664-545610.1159/000521028https://doaj.org/article/a53143f9f9b44f7fad925ff68bddb4752021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/521028https://doaj.org/toc/1664-5456Introduction: Revascularization surgery for adult moyamoya disease (MMD) with ischemic presentation changes cognitive function and prevents further cerebral ischemic events. Most studies, however, repeated neuropsychological evaluation within 1 year after surgery. Our previous prospective cohort study of adult patients with MMD with misery perfusion who underwent direct revascularization surgery showed cognitive improvement and decline in 31% and 44%, respectively, of the patients 2 months after surgery. The present prospective study aimed to elucidate the 5-year cognitive changes after direct revascularization surgery in adult patients with cerebral misery perfusion due to ischemic MMD by following the same patients. Methods: In total, 31 patients were prospectively followed up for 5 years after direct revascularization surgery. Five types of neuropsychological tests were performed preoperatively, 2 months after surgery, and at the end of the 5-year follow-up. Cerebral blood flow in the symptomatic cerebral hemisphere relative to that in the ipsilateral cerebellar hemisphere (hemispheric RCBF) was measured using brain perfusion single-photon emission computed tomography preoperatively and at the end of the 5-year follow-up. Results: Based on results of pre- and postoperative neuropsychological tests, 11, 10, and 10 patients showed cognitive improvement, no change in cognitive function, and cognitive decline, respectively, at the end of the 5-year follow-up. These ratios were not significantly different compared with those 2 months after surgery (cognitive improvement, no change in cognitive function, and cognitive decline in 10, eight, and 13 patients, respectively). Although hemispheric RCBF was significantly greater at the end of the 5-year follow-up than before surgery in patients with cognitive improvement (80.7 ± 6.1% versus 92.9 ± 5.5%; p = 0.0033) and in those showing no change in cognitive function (85.6 ± 3.5 versus 91.5 ± 5.2%; p = 0.0093), this value was significantly lower at the end of the 5-year follow-up than before surgery in patients with cognitive decline (83.8 ± 3.7 versus 81.0 ± 5.8%; p = 0.0367). Conclusion: One-third of adult patients with cerebral misery perfusion due to ischemic MMD who underwent direct revascularization surgery exhibited cognitive improvement, and one-third exhibited decline at the end of the 5-year follow-up. The former and latter patients had increased and decreased CBF, respectively, in the affected cerebral hemisphere at the end of the 5-year follow-up compared with preoperative brain perfusion.Shun UchidaYoshitaka KuboDaisuke OomoriMasahiro YabukiKei KitakamiShunrou FujiwaraKenji YoshidaMasakazu KobayashiKazunori TerasakiKuniaki OgasawaraKarger PublishersarticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENCerebrovascular Diseases Extra (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 Shun Uchida Yoshitaka Kubo Daisuke Oomori Masahiro Yabuki Kei Kitakami Shunrou Fujiwara Kenji Yoshida Masakazu Kobayashi Kazunori Terasaki Kuniaki Ogasawara Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
description	Introduction: Revascularization surgery for adult moyamoya disease (MMD) with ischemic presentation changes cognitive function and prevents further cerebral ischemic events. Most studies, however, repeated neuropsychological evaluation within 1 year after surgery. Our previous prospective cohort study of adult patients with MMD with misery perfusion who underwent direct revascularization surgery showed cognitive improvement and decline in 31% and 44%, respectively, of the patients 2 months after surgery. The present prospective study aimed to elucidate the 5-year cognitive changes after direct revascularization surgery in adult patients with cerebral misery perfusion due to ischemic MMD by following the same patients. Methods: In total, 31 patients were prospectively followed up for 5 years after direct revascularization surgery. Five types of neuropsychological tests were performed preoperatively, 2 months after surgery, and at the end of the 5-year follow-up. Cerebral blood flow in the symptomatic cerebral hemisphere relative to that in the ipsilateral cerebellar hemisphere (hemispheric RCBF) was measured using brain perfusion single-photon emission computed tomography preoperatively and at the end of the 5-year follow-up. Results: Based on results of pre- and postoperative neuropsychological tests, 11, 10, and 10 patients showed cognitive improvement, no change in cognitive function, and cognitive decline, respectively, at the end of the 5-year follow-up. These ratios were not significantly different compared with those 2 months after surgery (cognitive improvement, no change in cognitive function, and cognitive decline in 10, eight, and 13 patients, respectively). Although hemispheric RCBF was significantly greater at the end of the 5-year follow-up than before surgery in patients with cognitive improvement (80.7 ± 6.1% versus 92.9 ± 5.5%; p = 0.0033) and in those showing no change in cognitive function (85.6 ± 3.5 versus 91.5 ± 5.2%; p = 0.0093), this value was significantly lower at the end of the 5-year follow-up than before surgery in patients with cognitive decline (83.8 ± 3.7 versus 81.0 ± 5.8%; p = 0.0367). Conclusion: One-third of adult patients with cerebral misery perfusion due to ischemic MMD who underwent direct revascularization surgery exhibited cognitive improvement, and one-third exhibited decline at the end of the 5-year follow-up. The former and latter patients had increased and decreased CBF, respectively, in the affected cerebral hemisphere at the end of the 5-year follow-up compared with preoperative brain perfusion.
format	article
author	Shun Uchida Yoshitaka Kubo Daisuke Oomori Masahiro Yabuki Kei Kitakami Shunrou Fujiwara Kenji Yoshida Masakazu Kobayashi Kazunori Terasaki Kuniaki Ogasawara
author_facet	Shun Uchida Yoshitaka Kubo Daisuke Oomori Masahiro Yabuki Kei Kitakami Shunrou Fujiwara Kenji Yoshida Masakazu Kobayashi Kazunori Terasaki Kuniaki Ogasawara
author_sort	Shun Uchida
title	Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
title_short	Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
title_full	Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
title_fullStr	Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
title_full_unstemmed	Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
title_sort	long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/a53143f9f9b44f7fad925ff68bddb475
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Long-term cognitive changes after revascularization surgery in adult patients with ischemic moyamoya disease

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