Neuropsychological impacts of indirect revascularization for pediatric moyamoya disease
WooHyun Kim1, Eun-Young Lee2, Seong-Eun Park1
1Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea.
Purpose:
Moyamoya disease (MMD) commonly leads to neurocognitive impairment. This study was carried out to show that temporal encephaloduroarteriosynangiosis (EDAS) has a positive neuropsychological impact on pediatric MMD patients.
Methods:
Fifty-five participants diagnosed with MMD from 2008 to 2014 were included in this retrospective study. The mean age at the preoperative evaluation was 9.5 years and the mean age at postoperative evaluation was 10.4. The average interval of initial and follow-up test was 10 months. K-WISC-III, Rey-Kim memory test, Children's Color Trails test (CCTT), Wisconsin Card Sorting Test (WCST), and Advanced Test of Attention (ATA) were used to evaluate patient's neurocognitive profile.
Results:
In this study, preoperative and postoperative neuropsychological fields were compared. Prior operation, pediatric MMD patients showed 54.2% deficit of inattention but only around 2.5% deficit in verbal memory recall function. There was a significant increase of performance IQ and PO score component of PIQ improved almost 10 scores after surgery. For memorial function, there was an improvement of approximately 10 scores in MQ after the surgery. This study also showed parietal activation following surgical treatment which enhanced the ability to interpret visual materials, to register and to retrieve visual information. Interestingly, despite the parietal cover surgery, there was a significant improvement of performance on WCST and CCTT measuring the prefrontal executive function. Concerning failure to maintain set, no significant postoperative improvements were made. However, simple and selective visual attention on ATA was significantly improved postoperatively.
Conclusions:
The results from neuropsychological field comparison testifies the effectiveness of temporal EDAS in pediatric MMD patients. The surgery not only enhances the blood flow in operative regions, but it also improves the broad cerebral function including frontoparietal domains. Such alteration leads to overall advancement in cognitive function which are impaired due to MMD.
Insights
Temporal encephaloduroarteriosynangiosis (EDAS) surgery significantly improves neurocognitive function in pediatric Moyamoya disease (MMD) patients. The procedure enhances attention, memory, and executive functions, leading to better overall cognitive performance.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Neurosurgery
Background:
- Moyamoya disease (MMD) is a cerebrovascular disorder often leading to neurocognitive impairment in children.
- Surgical revascularization is a key treatment for MMD, but its impact on cognitive function requires further elucidation.
Purpose of the Study:
- To evaluate the neuropsychological impact of temporal encephaloduroarteriosynangiosis (EDAS) on pediatric patients with Moyamoya disease.
- To assess the effectiveness of EDAS in improving cognitive deficits associated with MMD.
Main Methods:
- A retrospective study of 55 pediatric MMD patients who underwent temporal EDAS between 2008 and 2014.
- Preoperative and postoperative neurocognitive assessments using standardized tests including K-WISC-III, Rey-Kim memory test, CCTT, WCST, and ATA.
- Comparison of cognitive performance before and after surgical intervention.
Main Results:
- Significant improvements were observed in performance IQ (PIQ) and memory quotient (MQ) post-surgery.
- Postoperative parietal activation correlated with enhanced visual information processing.
- Improvements in simple and selective visual attention (ATA) and executive functions (WCST, CCTT) were noted, despite no significant change in set maintenance.
Conclusions:
- Temporal EDAS is effective in improving neuropsychological deficits in pediatric MMD patients.
- The surgery enhances cerebral blood flow, leading to improved frontoparietal brain function and overall cognitive advancement.
- EDAS positively impacts attention, memory, and executive functions, crucial for managing MMD-related cognitive impairment.
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