Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort

• Published in: Acta neurochirurgica Vol. 164; no. 4; pp. 1037 - 1045
• Main Authors: Katakura, Yasukazu, Kubo, Yoshitaka, Dobashi, Kazumasa, Kimura, Kazuto, Fujiwara, Shunrou, Chida, Kohei, Kobayashi, Masakazu, Yoshida, Kenji, Terasaki, Kazunori, Ogasawara, Kuniaki
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.04.2022; Springer Nature B.V
• Subjects: Adult; Atrophy; Atrophy - etiology; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Cerebrovascular Circulation; Cerebrum - pathology; Cognitive ability; Cohort Studies; Computed tomography; Frontal lobe; Heart surgery; Humans; Interventional Radiology; Ischemia; Magnetic resonance imaging; Measuring techniques; Medicine; Medicine & Public Health; Middle Cerebral Artery - surgery; Minimally Invasive Surgery; Moyamoya disease; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - surgery; Neuroimaging; Neurology; Neuropsychology; Neuroradiology; Neurosurgery; Original Article - Vascular Neurosurgery - Ischemia; Patients; Perfusion; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Prospective Studies; Psychology; Single photon emission computed tomography; Surgery; Surgical Orthopedics; Tomography, Emission-Computed, Single-Photon; Vascular Neurosurgery - Ischemia; Arterial bypass surgery; Adult; Cognition; Moyamoya disease; Cerebral atrophy
• DOI: 10.1007/s00701-022-05141-w
• ISSN: 0942-0940; 0001-6268

Background Adult patients with moyamoya disease (MMD) occasionally exhibit cerebral hyperperfusion after arterial bypass surgery, leading to persistent cognitive decline. The present supplementary analysis of a prospective 5-year cohort study aimed to determine whether cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD causes cerebral atrophy, and whether the development of cerebral atrophy is related to persistent cognitive decline. Methods In total, 31 patients who underwent arterial bypass surgery also underwent fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and neuropsychological testing before surgery and at the end of a 5-year follow-up. The development of cerebral hyperperfusion and hyperperfusion syndrome after surgery was defined based on brain perfusion single-photon emission computed tomography (SPECT) findings and clinical symptoms. Univariate and multivariate logistic regression analyses of factors related to the development of cerebral atrophy on FLAIR MRI or cognitive decline on neuropsychological testing at the end of the 5-year follow-up were performed. Results Eleven patients (35%) developed cerebral atrophy in the frontal lobe where the superficial temporal artery was anastomosed. Cerebral hyperperfusion on brain perfusion SPECT (odds ratio [OR], 50.6; p  = 0.0008) or cerebral hyperperfusion syndrome (OR, 41.8; p  = 0.0026) was independently associated with the development of cerebral atrophy, and cerebral atrophy development was significantly associated with cognitive decline (OR, 47.7; p  = 0.0010). Conclusions Cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD can cause cerebral atrophy related to persistent cognitive decline.