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Decreased frontal white-matter diffusion and improved cognitive flexibility after burr-hole surgery in moyamoya
Lionel Calviere1,2,3, Paul Loubiere4, Melanie Planton5,6
1Departments of Neurology, University Hospital of Toulouse, Toulouse, France. calviere.l@chu-toulouse.fr.
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.
Insights
Multiple burr-hole surgery in Moyamoya Angioplasty (MMA) patients decreased frontal white matter (WM) apparent diffusion coefficient (ADC), indicating improved perfusion. This surgical intervention also enhanced executive functions, particularly cognitive flexibility.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Moyamoya Angioplasty (MMA) is linked to frontal white matter (WM) hypoperfusion and executive dysfunction, evidenced by increased apparent diffusion coefficient (ADC).
- Multiple burr-hole surgery offers a revascularization strategy for extensive frontal areas in MMA patients.
Purpose of the Study:
- To evaluate the impact of multiple burr-hole surgery on ADC values and cognitive functions in adults with MMA.
- To explore the relationship between microstructural changes in WM and cognitive improvements post-surgery.
Main Methods:
- ADC measurements were taken in frontal and posterior normal-appearing WM of 14 adult MMA patients before and 6 months after burr-hole surgery.
- Neuropsychological assessments focusing on executive and attentional functions were conducted on 10 patients pre- and post-operatively.
Main Results:
- Following surgery, frontal WM ADC significantly decreased (p <0.001), while posterior ADC remained unchanged.
- Cognitive flexibility, assessed by the Trail-making test part B, showed significant improvement (p=0.018).
Conclusions:
- Indirect revascularization via burr-hole surgery in MMA patients leads to reduced frontal WM ADC, suggesting enhanced cerebral perfusion.
- The observed decrease in ADC correlates with improvements in executive functions, particularly cognitive flexibility.
- ADC measurement shows promise as a tool to assess reversible microstructural WM damage and cognitive changes in MMA.
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