Angiographic, Cerebral Hemodynamic, and Cognitive Outcomes of Indirect Revascularization Surgery Alone for Adult Patients With Misery Perfusion due to Ischemic Moyamoya Disease

医学 烟雾病 血运重建 脑灌注压 灌注 心脏病学 认知 疾病 内科学 血流动力学 外科 麻醉 精神科 心肌梗塞
作者
Kazuto Kimura,Yoshitaka Kubo,Kazumasa Dobashi,Yasukazu Katakura,Kohei Chida,Masatoshi Kobayashi,Kenji Yoshida,Shunrou Fujiwara,Kazunori Terasaki,Tomohiro Kawamura,Kuniaki Ogasawara
出处
期刊:Neurosurgery [Oxford University Press]
卷期号:90 (6): 676-683 被引量:14
标识
DOI:10.1227/neu.0000000000001907
摘要

BACKGROUND: Revascularization surgery for adult patients with ischemic moyamoya disease (MMD) may improve both cognitive function and cerebral perfusion. OBJECTIVE: To 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. METHODS: Twenty 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. RESULTS: In 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). CONCLUSION: Indirect 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.
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