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Functional and Neuropsychological Outcome After Surgical Treatment of Moyamoya Disease
Siddharth B Joshi1, Rajeev Sharma1, Niveditha Manjunath1
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Background:
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive stenosis of the supraclinoid internal carotid artery. As a result of chronically decreased brain perfusion, eloquent areas of the brain become hypoperfused, leading to cognitive changes in patients. Repeated infarcts and bleeds produce clinically apparent neurologic deficits.
Objectives:
1) To study the functional and neuropsychological outcome in MMD after revascularization surgery. 2) To find postrevascularization correlation between functional and neuropsychological improvement and radiologic improvement.
Methods:
A single-center prospective and analytic study was carried out including 21 patients with MMD during the study period from March 2021 to December 2022. Patients were evaluated and compared before and after revascularization for functional, neuropsychological, and radiologic status.
Results:
Postoperative functional outcome in terms of modified Rankin Scale score showed improvement in 33.33% of cases (P = 0.0769). An overall improving trend was observed in different neuropsychological domains in both adult and pediatric age groups. However, the trend of neuropsychological improvement was better in adults compared with pediatric patients. Radiologic outcome in the form of the Angiographic Outcome Score (AOS) significantly improved after revascularization (P = 0.0001). There was a trend toward improvement in magnetic resonance imaging (MRI) perfusion in the middle cerebral artery and anterior cerebral artery territories, 4.7% (P = 0.075) and 9.33% (P = 0.058) respectively, compared with preoperative MRI perfusion.
Conclusions:
After revascularization, significant improvement occurred in functional and neuropsychological status. This result was also shown radiologically as evidenced by improvement in MRI perfusion and cerebral angiography.
Insights
Revascularization surgery improved functional and cognitive outcomes in Moyamoya disease (MMD) patients. Radiologic assessments confirmed enhanced brain perfusion and reduced stenosis, indicating successful surgical intervention for this rare cerebrovascular condition.
Area of Science:
- Neuroscience
- Vascular Surgery
- Neurology
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder causing progressive stenosis of the internal carotid artery, leading to hypoperfusion, cognitive decline, and neurological deficits.
- Chronic hypoperfusion in eloquent brain areas due to MMD can result in significant cognitive impairment and neurological deficits.
- Understanding the impact of surgical intervention on functional and radiological outcomes is crucial for managing MMD.
Purpose of the Study:
- To evaluate the functional and neuropsychological outcomes in Moyamoya disease (MMD) patients following revascularization surgery.
- To investigate the correlation between radiological improvements and functional/neuropsychological recovery after revascularization in MMD.
- To assess the efficacy of revascularization surgery in improving cerebral perfusion and clinical status in MMD patients.
Main Methods:
- A prospective, single-center study included 21 patients diagnosed with Moyamoya disease (MMD).
- Patients underwent comprehensive evaluations of functional, neuropsychological, and radiological status before and after revascularization surgery.
- Data analysis focused on changes in modified Rankin Scale scores, neuropsychological test results, Angiographic Outcome Score (AOS), and MRI perfusion.
Main Results:
- Revascularization surgery demonstrated a positive trend in functional outcomes, with 33.33% of patients showing improvement in modified Rankin Scale scores (P=0.0769).
- Significant radiological improvement was observed, evidenced by a marked increase in the Angiographic Outcome Score (AOS) (P=0.0001).
- Neuropsychological assessments revealed an overall improving trend in both adult and pediatric MMD patients, with adults showing a more pronounced improvement.
Conclusions:
- Revascularization surgery leads to significant improvements in both functional and neuropsychological status for patients with Moyamoya disease (MMD).
- Radiological evidence, including enhanced MRI perfusion and improved cerebral angiography, supports the clinical benefits observed post-surgery.
- The study highlights the effectiveness of revascularization in mitigating the effects of MMD and improving patient outcomes.
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