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Yoshioka H, Wakai T, Hashimoto K, Tateoka T, Fukuda N, Horiuchi R, Umeda T, Onishi H, Kinouchi H. Iodine-123-Iomazenil Single-Photon Emission Computed Tomography Revealed Recovery of Neuronal Viability in Association With Improvement of Cognitive Dysfunction After Revascularization in Moyamoya Disease. Neurosurgery 2024:00006123-990000000-01296. [PMID: 39041800 DOI: 10.1227/neu.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies indicate that 123I-iomazenil (123I-IMZ) single-photon emission computed tomography (SPECT) can demonstrate neuronal viability. Although cognitive dysfunction has been recognized as an important issue in adult patients with moyamoya disease (MMD), no standard neuroradiological methods to define such conditions have been established. We examined the relationship between cognitive function and 123I-IMZ SPECT before and after revascularization in patients with MMD. METHODS The study participants were 16 adult patients with MMD whose cerebrovascular reactivities were decreased only on the surgical sides of combined revascularization. Cognitive function was examined using the Mini-Mental State Examination (MMSE; cutoff: 27) and the Frontal Assessment Battery (FAB; cutoff: 16) before and at 3 to 6 months after surgery. 123I-iodoamphetamine (123I-IMP) SPECT with acetazolamide challenge and 123I-IMZ SPECT were performed concurrently while evaluating cognitive function. The radioreactivities of 123I-IMZ SPECT in regions with decreased cerebrovascular reactivities on 123I-IMP SPECT were investigated using affected-to-contralateral side asymmetry ratio (IMZ-ACR). RESULTS Twelve patients showed normal cognitive function (MMSE: 29.8 ± 0.4, FAB: 18 ± 0) before surgery. No evident laterality of 123I-IMZ uptake was seen (IMZ-ACR: 0.98 ± 0.04). Neither cognitive function nor 123I-IMZ SPECT worsened after surgery (MMSE: 29.8 ± 0.3, FAB: 18 ± 0, IMZ-ACR: 1.00 ± 0.04). By contrast, 4 patients presented cognitive dysfunction (MMSE: 24.3 ± 3.9, FAB: 14.8 ± 2.7) before revascularization. Preoperative imaging of these patients showed decreased 123I-IMZ uptake, and their IMZ-ACRs (0.83 ± 0.08) were significantly lower than those of the normal group. After revascularization, cognitive functions and 123I-IMZ uptake tended to ameliorate (MMSE: 27.5 ± 1.7, FAB: 16.3 ± 2.2, IMZ-ACR: 0.94 ± 0.09). CONCLUSION Preoperative cognitive function was associated with 123I-IMZ uptake in adult patients with MMD. After revascularization, cognitive function could be recovered in the viable areas of the brain, which is consistent with 123I-IMZ SPECT findings.
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Affiliation(s)
- Hideyuki Yoshioka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Takuma Wakai
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Koji Hashimoto
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Toru Tateoka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Norito Fukuda
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Ryo Horiuchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Takako Umeda
- Department of Radiology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Hiroshi Onishi
- Department of Radiology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
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Yingqian H, Dan W, Liping L, Zhiman L, Dingxiang X, Zhuhao L, Zhiyun Y, Li J, Jing Z. Longitudinal evaluation of cerebral perfusion evolution after revascularization surgery in moyamoya disease by CT perfusion. J Stroke Cerebrovasc Dis 2024; 33:107638. [PMID: 38360250 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To assess the longitudinal evolution of cerebral perfusion after revascularization surgery in patients with moyamoya disease (MMD) by CT perfusion (CTP). MATERIALS AND METHODS Thirty-one clinically confirmed MMD patients (12 males and 19 females, average age: 33.26 y, Suzuki stages 3 and 4: 19 and 11, respectively) who underwent revascularization surgery (bilateral (n=13) or unilateral (n=18)) were studied retrospectively. All patients underwent CTP examinations before and in the week after surgery and long-term (>3 months). CTP metrics (CBF, CBV, MTT, TTP, and delay TTP) were derived. The corresponding CTP metric values of the ROIs, which were manually drawn in the white matter (WM) and gray matter (GM), were recorded. RESULTS Six patients developed a new or progressive cerebral infarction/hemorrhage. In all patients, compared with the preoperative level, the TTP of GM and WM decreased in the short term after the surgery (P ≤ 0.005). Concurrently, the WM CBF increased significantly a week after surgery (P =0.02). However, in the long-term follow-up, the CBV and CBF in the GM and WM decreased to equal to or lower than the preoperative level, especially for CBV in the WM (P =0.012). Furthermore, cerebral perfusion began to decrease in the sixth month, and a continuous decline was observed over the next two months. It returned to the presurgical level after one year. In addition, the improvement in postsurgical perfusion was greater in Suzuki stage 3 patients than stage 4 patients. CONCLUSION Cerebral perfusion in patients with MMD improved shortly after surgery. However, in the long-term, brain perfusion decreased, most seriously in 6-8 months postoperatively, which might indicate that patients with MMD need timely follow-up and long-term intervention.
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Affiliation(s)
- Huang Yingqian
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Wei Dan
- Department of Radiology, Hui Ya Hospital of The First Affiliated Hospital, Sun Yat-sen University, Huizhou, 516000, PR China
| | - Lin Liping
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Lai Zhiman
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Xie Dingxiang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Li Zhuhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Yang Zhiyun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Jiang Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China.
| | - Zhao Jing
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China.
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Oakley CI, Lanzino G, Klaas JP. Neuropsychiatric Symptoms of Moyamoya Disease: Considerations for the Clinician. Neuropsychiatr Dis Treat 2024; 20:663-669. [PMID: 38532905 PMCID: PMC10964779 DOI: 10.2147/ndt.s440975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
Neurocognitive impairment in moyamoya disease is common, under recognized, and potentially devastating. The purpose of this paper is to provide an updated overview on this topic for the practicing clinician. We searched PubMed for keywords including cognitive impairment, neurocognitive dysfunction, and neuropsychological recovery in moyamoya disease. We summarized the literature to provide a concise review of the treatment and management of neuropsychiatric symptoms associated with moyamoya disease. Neuropsychiatric sequelae have conventionally been attributed to chronic cerebral hypoperfusion and/or stroke. Cognitive dysfunction in adults with moyamoya disease is most commonly in the form of impaired executive function, whereas intelligence is the predominant impairment in children with moyamoya disease. Pharmacotherapy for treatment of the neuropsychiatric symptoms associated with moyamoya disease is appropriate and can improve quality of life; however, careful consideration is needed to avoid adverse cerebrovascular events. It remains unclear as to whether surgical revascularization improves or stabilizes cognitive performance and outcomes. Additional prospective studies are warranted to better understand the long-term impact of revascularization on cognitive functioning in moyamoya disease.
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Affiliation(s)
| | | | - James P Klaas
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Nomura S, Oka F, Fujii N, Nishimoto T, Ishihara H. Outcome prediction of pediatric moyamoya disease using midterm cerebral blood flow measured between staged anastomoses. Childs Nerv Syst 2023; 39:1851-1859. [PMID: 36811729 DOI: 10.1007/s00381-023-05884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Cognitive outcomes of pediatric moyamoya disease are variable and difficult to predict on the basis of initial neurological signs and examinations. To determine the best early time point for outcome prediction, we retrospectively analyzed the correlation between cognitive outcomes and the cerebrovascular reserve capacity (CRC) measured before, between, and after staged bilateral anastomoses. METHODS Twenty-two patients aged 4-15 years were included in this study. CRC was measured before the first hemispheric surgery (preoperative CRC), 1 year after the first surgery (midterm CRC), and 1 year after the surgery on the other side (final CRC). The cognitive outcome was the Pediatric Cerebral Performance Category Scale (PCPCS) grade more than 2 years after the final surgery. RESULTS The 17 patients with favorable outcomes (PCPCS grades 1 or 2) showed a preoperative CRC of 4.9% ± 11.2%, which was not better than that of the five patients with unfavorable outcomes (grade 3; 0.3% ± 8.5%, p = 0.5). The 17 patients with favorable outcomes showed a midterm CRC of 23.8% ± 15.3%, which was significantly better than that of the five patients with unfavorable outcomes (-2.5% ± 12.1%, p = 0.004). The difference was much more significant for the final CRC, which was 24.8% ± 13.1% in the patients with favorable outcomes and -11.3% ± 6.7% in those with unfavorable outcomes (p = 0.00004). CONCLUSION Cognitive outcomes were first clearly discriminated by the CRC after the first-side unilateral anastomosis, which is the optimal early timing for the prediction of individual prognosis.
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Affiliation(s)
- Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
| | - Fumiaki Oka
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Natsumi Fujii
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Takuma Nishimoto
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Shen XX, Zhang HD, Fu HG, Xu JL, Zhang HT, Hou L, Zou ZX, Li B, Hao FB, Duan L, Han C. Association of cognitive function and hypoperfusion in Moyamoya disease patients without stroke. J Cereb Blood Flow Metab 2023; 43:542-551. [PMID: 36397212 PMCID: PMC10063831 DOI: 10.1177/0271678x221140349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/06/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022]
Abstract
The influence of hypoperfusion on cognition in patients with Moyamoya disease (MMD) is unclear. This study investigated cognitive function changes in MMD patients without stroke and illustrated the relationship between cognitive impairment and hypoperfusion. We prospectively performed a structured battery of seven neurocognitive tests on 115 adult MMD patients without stroke and 82 healthy controls. Hemodynamic assessment was performed using dynamic susceptibility contrast-enhanced MRI. The best subset regression (BSR) strategy was used to identify risk factors. Global cognition (MoCA), speed of information processing (TMT-A), executive function (TMT-B), visuospatial function (CDT), and verbal memory (CAVLT) were significantly poorer in MMD patients without stroke than in healthy controls. The TMT-B score significantly correlated with cerebral blood flow (CBF) in the bilateral lateral frontal lobes, centrum semiovale, and temporal lobes. The TMT-A and CAVLT scores significantly correlated with CBF in the left centrum semiovale (L-CSO) and temporal lobes. According to the BSR results, age, education, white matter lesions, and hypoperfusion of the L-CSO were risk factors for cognitive impairment. Hypoperfusion leads to multiple cognitive impairments in MMD patients without stroke. The perfusion of particular areas may help evaluate the cognitive function of MMD patients and guide therapeutic strategies.
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Affiliation(s)
- Xu-Xuan Shen
- Department of Neurosurgery, The Fifth School of Clinical Medicine, Anhui Medical University, Beijing, China
- Department of Neurosurgery, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hou-Di Zhang
- Department of Neurosurgery, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - He-Guan Fu
- Department of Neurosurgery, The Fifth School of Clinical Medicine, Anhui Medical University, Beijing, China
- Department of Neurosurgery, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jia-Li Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Tao Zhang
- Department of Radiology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Hou
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zheng-Xing Zou
- Department of Neurosurgery, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bin Li
- Department of Neurosurgery, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang-Bin Hao
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, The Fifth School of Clinical Medicine, Anhui Medical University, Beijing, China
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Cong Han
- Department of Neurosurgery, The Fifth School of Clinical Medicine, Anhui Medical University, Beijing, China
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Gao M, Lam CLM, Lui WM, Lau KK, Lee TMC. Preoperative brain connectome predicts postoperative changes in processing speed in moyamoya disease. Brain Commun 2022; 4:fcac213. [PMID: 36072648 PMCID: PMC9438963 DOI: 10.1093/braincomms/fcac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/09/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
Moyamoya disease is a rare cerebrovascular disorder associated with cognitive dysfunction. It is usually treated by surgical revascularization, but research on the neurocognitive outcomes of revascularization surgery is controversial. Given that neurocognitive impairment could affect the daily activities of patients with moyamoya disease, early detection of postoperative neurocognitive outcomes has the potential to improve patient management. In this study, we applied a well-established connectome-based predictive modelling approach to develop machine learning models that used preoperative resting-state functional connectivity to predict postoperative changes in processing speed in patients with moyamoya disease. Twelve adult patients with moyamoya disease (age range: 23–49 years; female/male: 9/3) were recruited prior to surgery and underwent follow-up at 1 and 6 months after surgery. Twenty healthy controls (age range: 24–54 years; female/male: 14/6) were recruited and completed the behavioural test at baseline, 1-month follow-up and 6-month follow-up. Behavioural results indicated that the behavioural changes in processing speed at 1 and 6 months after surgery compared with baseline were not significant. Importantly, we showed that preoperative resting-state functional connectivity significantly predicted postoperative changes in processing speed at 1 month after surgery (negative network: ρ = 0.63, Pcorr = 0.017) and 6 months after surgery (positive network: ρ = 0.62, Pcorr = 0.010; negative network: ρ = 0.55, Pcorr = 0.010). We also identified cerebro-cerebellar and cortico-subcortical connectivities that were consistently associated with processing speed. The brain regions identified from our predictive models are not only consistent with previous studies but also extend previous findings by revealing their potential roles in postoperative neurocognitive functions in patients with moyamoya disease. Taken together, our findings provide preliminary evidence that preoperative resting-state functional connectivity might predict the post-surgical longitudinal neurocognitive changes in patients with moyamoya disease. Given that processing speed is a crucial cognitive ability supporting higher neurocognitive functions, this study’s findings offer important insight into the clinical management of patients with moyamoya disease.
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Affiliation(s)
- Mengxia Gao
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong 999077 , China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong , Hong Kong 999077 , China
| | - Charlene L M Lam
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong 999077 , China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong , Hong Kong 999077 , China
| | - Wai M Lui
- Division of Neurosurgery, Queen Mary Hospital , Hong Kong 999077 , China
| | - Kui Kai Lau
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong , Hong Kong 999077 , China
- Division of Neurology, Department of Medicine, The University of Hong Kong , Hong Kong 999077 , China
| | - Tatia M C Lee
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong 999077 , China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong , Hong Kong 999077 , China
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Wang C, Sun C, Zhao Y, Song H, Li Z, Jin F, Cui C. RNF213 gene silencing upregulates transforming growth factor β1 expression in bone marrow-derived mesenchymal stem cells and is involved in the onset of Moyamoya disease. Exp Ther Med 2021; 22:1024. [PMID: 34373710 PMCID: PMC8343649 DOI: 10.3892/etm.2021.10456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/12/2020] [Indexed: 12/11/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic and progressive cerebrovascular occlusion disease, the precise etiology of which is poorly understood. Ring finger protein 213 (RNF213) has been previously identified as a susceptibility gene that serves an important role in angiogenesis, where it has been shown to be closely associated with the onset of MMD. Patients with MMD exhibit increased expression levels of various pro-inflammatory molecules and angiogenic factors. Under certain conditions, bone marrow mesenchymal stem cells (BMSCs) have the ability to differentiate to form neuron-like and microglia-like cells. In the present study, a total of 40 MMD patients and 40 healthy individuals were enrolled. ELISA assays revealed that the expression of serum vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGF-β1) were higher than that in healthy controls. Furthermore, rat BMSCs (rBMSCs) were isolated and cultured using the whole bone marrow adherence method, which were then phenotyped using flow cytometry. Osteogenic and adipogenic differentiation were determined by using Alizarin red and oil red O staining, respectively. RNF213 was knocked-down using a lentivirus-mediated short hairpin RNA system in passage three rBMSCs, and successful transfection of the RNF213 was confirmed by RT-qPCR and fluorescence imaging. The expression levels of VEGF and TGF-β1 in these rBMSCs were measured on days 7 and 14, respectively. The results demonstrated that RNF213 knockdown upregulated TGF-β1 at both protein and mRNA levels, but did not exert any effect on VEGF gene expression. In conclusion, these findings suggested that that RNF213 knockdown may contribute to aberrant TGF-β1 expression via a pathway that remains to be unidentified, indicating that quantitative changes in RNF213 gene expression may serve an important role in the pathogenesis of MMD.
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Affiliation(s)
- Changshui Wang
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Cuilian Sun
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Yueshu Zhao
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Huimin Song
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Zhengyou Li
- Department of Neurosyrgery, Shandong Province Western Hospital, Shandong Province ENT Hospital, Jinan, Shandong 250022, P.R. China
| | - Feng Jin
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Changmeng Cui
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
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Callen AL, Caton MT, Rutledge C, Raper D, Narvid J, Villanueva-Meyer JE, Abla A. The Effect of Extracranial-to-Intracranial Bypass on Cerebral Vasoreactivity: A 4D Flow MRI Pilot Study. J Neuroimaging 2020; 30:587-592. [PMID: 32862480 DOI: 10.1111/jon.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Extracranial-to-intracranial (EC-IC) surgical bypass improves cerebral blood flow (CBF) and cerebrovascular vasoreactivity (CVR) for patients with carotid occlusion. Bypass graft patency and contribution of the graft to the postoperative increase in CVR are challenging to assess. To assess the effectiveness of 4D flow magnetic resonance imaging (MRI) to evaluate bypass graft patency and flow augmentation through the superficial temporal artery (STA) before and after EC-IC bypass. METHODS Three consecutive patients undergoing EC-IC bypass for carotid occlusion were evaluated pre- and postoperatively using CVR testing with pre- and poststimulus 4D flow-MRI for assessment of the bypass graft and intracranial vasculature. RESULTS Preoperatively, 2 patients (patients 1 and 3) did not augment flow through either native STA. The third, who had evidence of extensive native EC-IC collateralization on digital subtraction angiography (DSA), did augment flow through the STA preoperatively (CVR = 1). Postoperatively, all patients demonstrated CVR > 1 on the side of bypass. The patient who had CVR > 1 preoperatively demonstrated the greatest increase in resting postoperative graft flow (from 40 to 130 mL/minute), but the smallest CVR, with a poststimulus graft flow of 160 mL/minute (CVR = 1.2). The 2 patients who did not demonstrate augmentation of graft flow preoperatively augmented postoperatively from 10 to 20 mL/minute (CVR = 2.0) and 10-80 mL/minute (CVR = 8.0), respectively. Intracranial flow was simultaneously interrogated. Two patients demonstrated mild reductions in resting flow velocities in all interrogated vessels immediately following bypass. The patient who underwent CVR testing on postoperative day 48 demonstrated a stable or increased flow rate in most intracranial vessels. CONCLUSION Four-dimensional flow MRI allows for noninvasive, simultaneous interrogation of the intra- and extracranial arterial vasculature during CVR testing, and reveals unique paradigms in cerebrovascular physiology. Observing these flow patterns may aid in improved patient selection and more detailed postoperative evaluation for patients undergoing EC-IC bypass.
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Affiliation(s)
- Andrew L Callen
- Department of Radiology, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Michael T Caton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Caleb Rutledge
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA
| | - Daniel Raper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA
| | - Jared Narvid
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Adib Abla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA
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Hara S, Kudo T, Hayashi S, Inaji M, Tanaka Y, Maehara T, Ishii K, Nariai T. Improvement in cognitive decline after indirect bypass surgery in adult moyamoya disease: implication of 15O-gas positron emission tomography. Ann Nucl Med 2020; 34:467-475. [PMID: 32378149 DOI: 10.1007/s12149-020-01473-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the characteristics of patients with moyamoya disease (MMD) who show improvement in their cognitive decline after bypass surgery by analyzing the hemodynamic and metabolic parameters of 15O-gas positron emission tomography (PET). MATERIALS AND METHODS We retrospectively analyzed adult patients with MMD who were evaluated with PET and cognitive tests before and approximately one year after indirect bypass surgery. The PET parameters of the left Rolandic area were compared between patients who did and did not show improvement in their cognitive decline. RESULTS Of the 19 patients analyzed, fourteen (74%) showed improvement in either the verbal or performance intelligence quotient (VIQ or PIQ). Three out of four patients with perioperative infarction experienced significant cognitive decline. The preoperative oxygen extraction fraction (OEF) was significantly higher in patients who showed improvement in their cognitive decline in terms of the PIQ than in those patients who did not (P = 0.03). The postoperative increase in the cerebral metabolic rate of oxygen (CMRO2) was significantly higher in patients who showed improvement in their cognitive decline in terms of the VIQ than in those who did not (P = 0.02). CONCLUSION Adult patients with MMD might show improvement in their cognitive decline after successful indirect bypass surgery if they have a severely increased regional OEF before the surgery and an increased regional CMRO2 after the surgery. CLINICAL TRIAL REGISTRATION URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000027949.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Takumi Kudo
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shihori Hayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
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Quon JL, Kim LH, MacEachern SJ, Maleki M, Steinberg GK, Madhugiri V, Edwards MSB, Grant GA, Yeom KW, Forkert ND. Early Diffusion Magnetic Resonance Imaging Changes in Normal-Appearing Brain in Pediatric Moyamoya Disease. Neurosurgery 2020; 86:530-537. [PMID: 31245817 DOI: 10.1093/neuros/nyz230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Moyamoya disease often leads to ischemic strokes visible on diffusion-weighted imaging (DWI) and T2-weighted magnetic resonance imaging (MRI) with subsequent cognitive impairment. In adults with moyamoya, apparent diffusion coefficient (ADC) is correlated with regions of steal phenomenon and executive dysfunction prior to white matter changes. OBJECTIVE To investigate quantitative global diffusion changes in pediatric moyamoya patients prior to explicit structural ischemic damage. METHODS We retrospectively reviewed children (<20 yr old) with moyamoya disease and syndrome who underwent bypass surgery at our institution. We identified 29 children with normal structural preoperative MRI and without findings of cortical infarction or chronic white matter ischemic changes. DWI datasets were used to calculate ADC maps for each subject as well as for 60 age-matched healthy controls. Using an atlas-based approach, the cerebral white matter, cerebral cortex, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, nucleus accumbens, and brainstem were segmented in each DWI dataset and used to calculate regional volumes and ADC values. RESULTS Multivariate analysis of covariance using the regional ADC and volume values as dependent variables and age and gender as covariates revealed a significant difference between the groups (P < .001). Post hoc analysis demonstrated significantly elevated ADC values for children with moyamoya in the cerebral cortex, white matter, caudate, putamen, and nucleus accumbens. No significant volume differences were found. CONCLUSION Prior to having bypass surgery, and in the absence of imaging evidence of ischemic stroke, children with moyamoya exhibit cerebral diffusion changes. These findings could reflect microstructural changes stemming from exhaustion of cerebrovascular reserve.
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Affiliation(s)
- Jennifer L Quon
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Lily H Kim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Sarah J MacEachern
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Maryam Maleki
- Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford, California
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Venkatesh Madhugiri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Michael S B Edwards
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.,Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.,Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California
| | - Kristen W Yeom
- Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford, California
| | - Nils D Forkert
- Division of Image Science, Department of Radiology, University of Calgary, Calgary, Canada
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11
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Calviere L, Loubiere P, Planton M, Cazzola V, Catalaa I, Mirabel H, Sol JC, Bonneville F. Decreased frontal white-matter diffusion and improved cognitive flexibility after burr-hole surgery in moyamoya angiopathy. BMC Neurol 2020; 20:30. [PMID: 31959138 PMCID: PMC6970285 DOI: 10.1186/s12883-020-1614-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Moyamoya Angioplasty (MMA), increased apparent diffusion coefficient (ADC) in frontal white matter (WM) with a normal appearance has been associated with frontal hypoperfusion and executive dysfunction. Multiple burr-hole surgery enables the revascularization of large frontal areas. GOAL To assess the effect of multiple burr-hole surgery on the ADC and cognitive functions in adults with MMA. METHODS ADC was measured in 26 brain hemispheres of 14 consecutive adults with MMA (9 women, mean age ± SD: 38.1 ± 10.7 years) prior to and 6 months after burr-hole surgery. ADC was obtained from regions of interest located in frontal and posterior (temporo-occipital) normal-appearing WM. Ten patients had neuropsychological assessment that focused on executive and attentional functions before and after surgery. RESULTS Anterior and posterior ADC values did not differ before surgery (815.8 ± 60.1 vs. 812.1 ± 35.3 mm2/s, p = 0.88). After surgery, frontal ADC was lower than prior to surgery (789.9 ± 64.5 vs. 815.8 ± 60.1 mm2/s; p <0.001) whereas no change occurred in posterior ADC (p = 0.31). Trail-making test part B median z-score increased from - 1.47 to - 0.21 (p = 0.018), suggesting improved cognitive flexibility. CONCLUSION In adults with MMA, indirect revascularization with burr-hole is followed by a decrease of ADC in normal-appearing frontal WM and may have improved some executive functions in the flexibility process. Change in ADC may reflect the improvement in cerebral perfusion after surgery. The measuring of ADC may be a promising tool in exploring potentially reversible microstructural WM damage related to hypoperfusion and cognitive change in MMA.
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Affiliation(s)
- Lionel Calviere
- Departments of Neurology, University Hospital of Toulouse, Toulouse, France. .,Toulouse Neuro-imaging Centre, INSERM, University Paul Sabathier, Toulouse, France. .,Department of Neurology, Hopital Pierre Paul Riquet, Place Dr. Baylac, 30159, Toulouse, France.
| | - Paul Loubiere
- Departments of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Melanie Planton
- Toulouse Neuro-imaging Centre, INSERM, University Paul Sabathier, Toulouse, France.,Department of Neuropsychology, University Hospital of Toulouse, Toulouse, France
| | - Vanessa Cazzola
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Isabelle Catalaa
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Helene Mirabel
- Department of Neuropsychology, University Hospital of Toulouse, Toulouse, France
| | - Jean Christophe Sol
- Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France
| | - Fabrice Bonneville
- Toulouse Neuro-imaging Centre, INSERM, University Paul Sabathier, Toulouse, France.,Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
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12
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Neuropsychological impairment in adults with moyamoya angiopathy: preoperative assessment and correlation to MRI and H 215O PET. Neurosurg Rev 2019; 43:1615-1622. [PMID: 31728848 DOI: 10.1007/s10143-019-01192-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
Patients with moyamoya angiopathy (MMA) are known to have an increased risk of impaired executive function (dysexecutive cognitive syndrome (DCS)). Numbers of moyamoya patients with DCS vary strongly in the literature; evidence of a correlation to affected vascular territories is low. This study aims to identify cognitive impairment in adult moyamoya patients and to correlate findings with imaging results. In addition, the predictive value of individual tests for the identification of DCS was analyzed. Neuropsychological test data of 41 adult moyamoya patients was analyzed for a possible correlation with territorial hypoperfusion on H215O PET with acetazolamide (ACZ) challenge (cerebrovascular reserve-CVR) and infarction patterns observed in MRI. Each vascular territory was analyzed separately and correlated to neuropsychological test results and to the presence of DCS. In total, 41.5% of patients presented with DCS. Significant association of DCS and affection of the right middle cerebral artery (MCA) territory was seen for insufficient CVR in PET (p = 0.030) and for patients with infarctions seen in MRI (p = 0.014). Analysis of individual neuropsychological test results confirmed the main association with the right MCA territory, as well as some association with the right anterior cerebral artery (ACA) territory. Analysis of a subgroup of patients with chronic disease on MRI (presence of large post-infarction gliosis and brain atrophy in affected territories) revealed a significantly higher risk for DCS (85% affected) than non-chronic patients (21% affected) (p < 0.001). Analysis of neuropsychological test data in this moyamoya cohort reveals DCS in 41.5% of all patients. Correlation between DCS and an impairment of CVR seen in PET and/or infarctions seen in MRI was significant for the right MCA territory. Patients with chronic disease had a significantly higher risk for DCS than non-chronic patients (p < 0.001).
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13
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Quon JL, Kim LH, Lober RM, Maleki M, Steinberg GK, Yeom KW. Arterial spin-labeling cerebral perfusion changes after revascularization surgery in pediatric moyamoya disease and syndrome. J Neurosurg Pediatr 2019; 23:486-492. [PMID: 30738390 DOI: 10.3171/2018.11.peds18498] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Moyamoya disease is a dynamic cerebrovascular condition that often requires vascular surveillance. Arterial spin labeling (ASL) is an MR perfusion method that is increasingly used for stroke and other various neurovascular pathologies. Unlike perfusion-weighted MRI, ASL uses endogenous water molecules for signal and therefore obviates gadolinium use; and provides direct, not relative, quantitative cerebral blood flow (CBF) measures. Presently, the potential role of ASL for evaluating postoperative pediatric moyamoya patients is relatively unexplored. This study investigated the role for ASL in evaluating cerebral hemodynamic changes in children who underwent revascularization surgery. METHODS This retrospective study examined 15 consecutive pediatric patients with moyamoya disease (n = 7) or moyamoya syndrome (n = 8) presenting between 2010 and 2014 who underwent revascularization and in whom 3T ASL was performed pre- and postoperatively. Postoperative MRI at least 3 months after revascularization procedure was used for analysis. Quantitative CBF in various vascular territories was interrogated: anterior, middle, and posterior cerebral arteries, and basal ganglia supplied by the lenticulostriate collaterals, resulting in evaluation of 20 brain regions. RESULTS After revascularization, CBF in the high middle cerebral artery territory significantly increased (p = 0.0059), accompanied by a decrease in CBF to the ipsilateral lenticulostriate-supplied basal ganglia (p = 0.0053). No perfusion changes occurred in the remaining cerebral vascular territories after surgery. CONCLUSIONS ASL-based quantitative CBF showed improved cerebral perfusion to the middle cerebral artery territory after revascularization in children with both moyamoya syndrome and disease. Reduced perfusion to the basal ganglia might reflect pruning of the lenticulostriate collaterals, potentially from effects of revascularization. ASL can quantitatively evaluate hemodynamic changes in children with moyamoya after revascularization, and it may be a useful adjunct to routine clinical MRI surveillance.
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Affiliation(s)
- Jennifer L Quon
- 1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Lily H Kim
- 1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Robert M Lober
- 2Department of Neurosurgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Maryam Maleki
- 3John Wayne Cancer Institute, Santa Monica, California; and
| | - Gary K Steinberg
- 1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Kristen W Yeom
- 4Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
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14
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Kolb B, Fadel H, Rajah G, Saber H, Luqman A, Rangel-Castilla L. Effect of revascularization on cognitive outcomes in intracranial steno-occlusive disease: a systematic review. Neurosurg Focus 2019; 46:E14. [PMID: 30717064 DOI: 10.3171/2018.11.focus18517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESteno-occlusive diseases of the cerebral vasculature have been associated with cognitive decline. The authors performed a systematic review of the existing literature on intracranial steno-occlusive disease, including intracranial atherosclerosis and moyamoya disease (MMD), to determine the extent and quality of evidence for the effect of revascularization on cognitive performance.METHODSA systematic search of PubMed/MEDLINE, the Thomson Reuters Web of Science Core Collection, and the KCI Korean Journal Database was performed to identify randomized controlled trials (RCTs) in the English-language literature and observational studies that compared cognitive outcomes before and after revascularization in patients with steno-occlusive disease of the intracranial vasculature, from which data were extracted and analyzed.RESULTSNine papers were included, consisting of 2 RCTs and 7 observational cohort studies. Results from 2 randomized trials including 142 patients with symptomatic intracranial atherosclerotic steno-occlusion found no additional benefit to revascularization when added to maximal medical therapy. The certainty in the results of these trials was limited by concerns for bias and indirectness. Results from 7 observational trials including 282 patients found some cognitive benefit for revascularization for symptomatic atherosclerotic steno-occlusion and for steno-occlusion related to MMD in children. The certainty of these conclusions was low to very low, due to both inherent limitations in observational studies for inferring causality and concerns for added risk of bias and indirectness in some studies.CONCLUSIONSThe effects of revascularization on cognitive performance in intracranial steno-occlusive disease remain uncertain due to limitations in existing studies. More well-designed randomized trials and observational studies are needed to determine if revascularization can arrest or reverse cognitive decline in these patients.
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15
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McKetton L, Venkatraghavan L, Rosen C, Mandell DM, Sam K, Sobczyk O, Poublanc J, Gray E, Crawley A, Duffin J, Fisher JA, Mikulis DJ. Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease. AJNR Am J Neuroradiol 2018; 40:45-50. [PMID: 30573457 DOI: 10.3174/ajnr.a5912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE One feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI. The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease. MATERIALS AND METHODS We recruited 35 patients with steno-occlusive disease, Moyamoya disease (n = 24), Moyamoya syndrome (n = 3), atherosclerosis (n = 6), vasculitis (n = 1), and idiopathic stenosis (n = 1), who underwent unilateral brain revascularization using a direct superficial temporal artery-to-MCA bypass (19 women; mean age, 45.8 ± 16.5 years). WM cerebrovascular reactivity was measured preoperatively and postoperatively using blood oxygen level-dependent (BOLD) MR imaging during iso-oxic hypercapnic changes in end-tidal carbon dioxide and was expressed as %Δ BOLD MR signal intensity per millimeter end-tidal partial pressure of CO2. RESULTS WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory (mean ± SD, -0.0005 ± 0.053 to 0.053 ± 0.046 %BOLD/mm Hg; P < .0001) and in the anterior cerebral artery territory (mean, 0.0015 ± 0.059 to 0.021 ± 0.052 %BOLD/mm Hg; P = .005). There was no difference in WM cerebrovascular reactivity in the ipsilateral posterior cerebral artery territory nor in the vascular territories of the nonrevascularized hemisphere (P < .05). CONCLUSIONS Cerebral revascularization surgery is an effective treatment for reversing preoperative cerebrovascular reactivity deficits in WM. In addition, direct-STA-MCA bypass may prevent recurrence of preoperative symptoms.
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Affiliation(s)
- L McKetton
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - L Venkatraghavan
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada
| | - C Rosen
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - D M Mandell
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - K Sam
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.).,Russell H. Morgan Department of Radiology and Radiological Science (K.S.), John Hopkins School of Medicine, Baltimore, Maryland
| | - O Sobczyk
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Poublanc
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - E Gray
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - A Crawley
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Duffin
- Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - J A Fisher
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada.,Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - D J Mikulis
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.) .,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
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16
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Rosen C, McKetton L, Russell J, Sam K, Poublanc J, Crawley A, Han JS, Sobczyk O, Duffin J, Mandell DM, Tymianski M, Fisher JA, Mikulis DJ, Venkatraghavan L. Long-term changes in cerebrovascular reactivity following EC-IC bypass for intracranial steno-occlusive disease. J Clin Neurosci 2018; 54:77-82. [PMID: 29907385 DOI: 10.1016/j.jocn.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
The purpose of this retrospective observational study is to investigate the long-term changes in cerebrovascular reactivity (CVR) as a measure of cerebral hemodynamics in patients with intracranial steno-occlusive disease (IC-SOD) after they have undergone an Extracranial-intracranial (EC-IC) bypass. Twenty-six patients suffering from IC-SOD were selected from our CVR database. Nineteen patients underwent unilateral and 7 underwent bilateral revascularization. CVR measurements were done using BOLD-MRI and precisely controlled CO2 and expressed as ΔBOLD (%)/Δ PETCO2 (mmHg). Trends in CVR over time were compared in both vascularized and non-vascularized hemispheres. Repeated measures analysis of variance with Greenhouse-Geisser correction was used to determine CVR changes within the grey matter MCA for longitudinal assessments. Overall, re-vascularized hemisphere showed a significant increase in CVR at the first follow-up, followed by a slight decrease at the second follow-up that significantly increased compared to the pre-bypass. However, the changes in the postoperative CVR were quite variable across the patients. Similar variability was seen in subsequent follow-ups, with a slight overall decline in the long term CVR as compared with first post-operative CVR. Our study demonstrates that EC-IC bypass has a beneficial long-term effect on cerebral hemodynamics and this effect varies between patients probably due to the variability in the underlying vascular pattern receiving the bypass. Hence, in the postoperative follow-up of patients routine functional imaging to monitor cerebral hemodynamics may be useful as the risk of stroke and cognitive decline remain present with impaired CVR.
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Affiliation(s)
- Casey Rosen
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Larissa McKetton
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Jeremy Russell
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Sam
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada; Department of Physiology, The University of Toronto, Toronto, ON, Canada
| | - Julien Poublanc
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Adrian Crawley
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Jay S Han
- Department of Anaesthesia, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Institute of Medical Sciences, The University of Toronto, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, The University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, University Health Network, Toronto, ON, Canada
| | - Danny M Mandell
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Michael Tymianski
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Joseph A Fisher
- Department of Physiology, The University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, The University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Department of Physiology, The University of Toronto, Toronto, ON, Canada
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17
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Sakamoto Y, Okamoto S, Maesawa S, Bagarinao E, Araki Y, Izumi T, Watanabe H, Sobue G, Wakabayashi T. Default Mode Network Changes in Moyamoya Disease Before and After Bypass Surgery: Preliminary Report. World Neurosurg 2018; 112:e652-e661. [PMID: 29374613 DOI: 10.1016/j.wneu.2018.01.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Neurocognitive impairment is often reported in moyamoya disease. We aimed to detect default mode network (DMN) alterations using resting-state functional magnetic resonance imaging and their association with neurocognitive impairments. In addition, the influence of surgical treatment was individually evaluated. METHODS Seven patients with moyamoya disease underwent preoperative resting-state functional magnetic resonance imaging and neuropsychologic tests. We compared the resting-state networks (RSNs) of our patients with those obtained from relatively large cohort datasets (127 healthy controls) using group independent component analysis with dual regression analysis. We also explored correlations between RSN alterations and neuropsychologic scores. We evaluated individuals again 6 months after surgery to identify changes. RESULTS Patients had statistically significant differences in DMN connectivity compared with healthy controls. There were marked changes in functional connectivity of the ventral DMN of patients with low working memory and performance speed scores. These changes were characterized by increases and decreases in various locations. In contrast, patients with average or high neuropsychologic scores showed similar connectivity to the controls. In 5 patients who underwent vascular reconstruction surgery, DMN functional connectivity changed to resemble that of healthy controls. CONCLUSIONS In moyamoya disease, working memory and performance speed scores were inversely correlated to the degree of disruption of the DMN, suggesting a possible relationship between higher cognitive function and orderliness of fundamental brain networks. Vascular reconstruction surgery may contribute to normalization of brain networks. Analysis of RSNs may produce potential biomarkers for cognition in moyamoya disease.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sho Okamoto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.
| | - Epifanio Bagarinao
- The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hirohisa Watanabe
- The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Gen Sobue
- The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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18
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Zeifert PD, Karzmark P, Bell-Stephens TE, Steinberg GK, Dorfman LJ. Neurocognitive Performance After Cerebral Revascularization in Adult Moyamoya Disease. Stroke 2017; 48:1514-1517. [PMID: 28487332 DOI: 10.1161/strokeaha.116.016028] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/01/2017] [Accepted: 03/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral revascularization using EC-IC bypass is widely used to treat moyamoya disease, but the effects of surgery on cognition are unknown. We compared performance on formal neurocognitive testing in adults with moyamoya disease before and after undergoing direct EC-IC bypass. METHODS We performed a structured battery of 13 neurocognitive tests on 84 adults with moyamoya disease before and 6 months after EC-IC bypass. The results were analyzed using reliable change indices for each test, to minimize test-retest variability and practice effects. RESULTS Twelve patients (14%) showed significant decline postoperatively, 9 patients (11%) improved, and 63 patients (75%) were unchanged. Similar results were obtained when the analysis was confined to those who underwent unilateral (33) or bilateral (51) revascularization. CONCLUSIONS The majority of patients showed neither significant decline nor improvement in neurocognitive performance after EC-IC bypass surgery. Uncomplicated EC-IC bypass seems not to be a risk factor for cognitive decline in this patient population.
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Affiliation(s)
- Penelope D Zeifert
- From the Department of Neurology and Neurological Sciences (P.D.Z., P.K., G.K.S., L.J.D.), Department of Neurosurgery (P.D.Z., T.E.B.-S., G.K.S.), and Neuropsychology Service (P.D.Z., P.K.), Stanford Stroke Center, Stanford University Medical Center, CA
| | - Peter Karzmark
- From the Department of Neurology and Neurological Sciences (P.D.Z., P.K., G.K.S., L.J.D.), Department of Neurosurgery (P.D.Z., T.E.B.-S., G.K.S.), and Neuropsychology Service (P.D.Z., P.K.), Stanford Stroke Center, Stanford University Medical Center, CA
| | - Teresa E Bell-Stephens
- From the Department of Neurology and Neurological Sciences (P.D.Z., P.K., G.K.S., L.J.D.), Department of Neurosurgery (P.D.Z., T.E.B.-S., G.K.S.), and Neuropsychology Service (P.D.Z., P.K.), Stanford Stroke Center, Stanford University Medical Center, CA
| | - Gary K Steinberg
- From the Department of Neurology and Neurological Sciences (P.D.Z., P.K., G.K.S., L.J.D.), Department of Neurosurgery (P.D.Z., T.E.B.-S., G.K.S.), and Neuropsychology Service (P.D.Z., P.K.), Stanford Stroke Center, Stanford University Medical Center, CA
| | - Leslie J Dorfman
- From the Department of Neurology and Neurological Sciences (P.D.Z., P.K., G.K.S., L.J.D.), Department of Neurosurgery (P.D.Z., T.E.B.-S., G.K.S.), and Neuropsychology Service (P.D.Z., P.K.), Stanford Stroke Center, Stanford University Medical Center, CA.
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