• Kazuto Kimura, Yoshitaka Kubo, Kazumasa Dobashi, Yasukazu Katakura, Kohei Chida, Masakazu Kobayashi, Kenji Yoshida, Shunrou Fujiwara, Kazunori Terasaki, Tsuyoshi Kawamura, and Kuniaki Ogasawara.
• Department of Neurosurgery, School of Medicine, Iwate Medical University, Japan.
• Neurosurgery. 2022 Jun 1; 90 (6): 676683676-683.

BackgroundRevascularization surgery for adult patients with ischemic moyamoya disease (MMD) may improve both cognitive function and cerebral perfusion.ObjectiveTo determine angiographic, cerebral hemodynamic, and cognitive outcomes of indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic MMD (IDR group) and to test the superiority of indirect revascularization surgery for cognitive improvement by conducting comparisons with historical control patients who had undergone direct revascularization surgery (DR group) through prospective cohort study with historical controls.MethodsTwenty adult patients with cerebral misery perfusion underwent encephalo-duro-myo-arterio-pericranial-synangiosis alone. Cerebral angiography through arterial catheterization, brain perfusion single-photon emission computed tomography, and neuropsychological testing were performed preoperatively and at 6 months postoperatively.ResultsIn 17 patients of the IDR group, collateral flows that were newly formed after surgery on angiograms fed more than one-third of the middle cerebral artery (MCA) cortical territory. In the IDR group, perfusion in the MCA territory was significantly increased after surgery (P < .0001), and the difference in MCA perfusion between before and after surgery was significantly greater (P = .0493) compared with the DR group. Improved cognition was significantly more frequent in the IDR group (65%) than in the DR group (31%, P = .0233).ConclusionIndirect revascularization surgery alone forms sufficient collateral circulation, improves cerebral hemodynamics, and recovers cognitive function in adult patients with misery perfusion due to ischemic MMD. The latter 2 beneficial effects may be higher when compared with patients undergoing direct revascularization surgery.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

20 keywords...

hide…