J Korean Neurosurg Soc.  2014 Sep;56(3):188-193. 10.3340/jkns.2014.56.3.188.

Preliminary Study of Neurocognitive Dysfunction in Adult Moyamoya Disease and Improvement after Superficial Temporal Artery-Middle Cerebral Artery Bypass

• Baek HJ
• Chung SY
• Park MS
• Kim SM
• Park KS
• Son HU

• KMID: 2339955
• DOI: http://doi.org/10.3340/jkns.2014.56.3.188

Abstract

OBJECTIVE
Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease of unknown etiology. In addition, the neurocognitive impairment of adults with MMD is infrequently reported and, to date, has not been well described. We attempted to determine both the neurocognitive profile of adult moyamoya disease and whether a superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis can improve the neurocognitive impairment in exhibiting hemodynamic disturbance without stroke.
METHODS
From September 2010 through November 2012, 12 patients with angiographically diagnosed MMD underwent STA-MCA anastomosis for hemodynamic impairment. Patients with hypoperfusion and impaired cerebrovascular reserve (CVR) capacity but without evidence of ischemic stroke underwent a cognitive function test, the Seoul Neuropsychological Screening Battery (SNSB). Five patients agreed to undergo a follow-up SNSB test. Data from preoperative and postoperative neurocognitive function tests were compared and analyzed.
RESULTS
Five of 12 patients were enrolled. The median age was 45 years (range, 24-55 years). A comparison of preoperative to postoperative status of SNSB, memory domain, especially delayed recall showed significant improvement. Although most of the domains showed improvement after surgery, the results were not statistically significant.
CONCLUSION
In our preliminary study, large proportions of adult patients with MMD demonstrate disruption of cognitive function. This suggests the possibility of chronic hypoperfusion as a primary cause of the neurocognitive impairment. When preoperative and postoperative status of cognitive function was compared, memory domain showed remarkable improvement. Although further study is needed, neurocognitive impairment may be an indication for earlier intervention with reperfusion procedures that can improve cognitive function.

Keyword

Neurocognitive impairment; Moyamoya disease; STA-MCA anastomosis

MeSH Terms

Adult*
Cerebral Arteries*
Follow-Up Studies
Hemodynamics
Humans
Mass Screening
Memory
Moyamoya Disease*
Reperfusion
Seoul
Stroke

Figure

• 

  Fig. 1 A 46-years-old woman with dizziness underwent right STA-MCA anastomosis surgery. A : Preoperative TFCA image shows bilateral distal ICA occlusion with development of collateral vessels. White arrows indicate moyamoya vessels in both ICAs. B and C : STA-MCA anastomosis was performed in the right frontoparietal area. Postoperative TFCA was performed and STA-MCA anastomosis flow was present. D : There was no evidence of acute stoke with a preoperative diffusion imaging study. E and F : Preoperative MRI perfusion shows prolongation of MTT (E) and TTP (F) in both hemispheres, especially in the right frontal area. G (without acetazolamide) and H (with acetazolamide) : Brain perfusion SPECT performed to evaluate preoperative reserve capacity of the patient; it revealed a suspicion of impaired reserve capacity in the right frontal lobe. I and J : Post-operation image study shows improvement of MTT (I) and TTP (J) prolongation and hemodynamic status in the right frontal lobe. White arrow shows the perfusion improvement following surgery. K (without acetazolamide) and L (with acetazolamide) : Brain perfusion SPECT performed on postoperative day 7 shows improvement in reserve capacity when the preoperative acetazolamide stress test is compared to the postoperative acetazolamide stress test. STA-MCA : superficial temporal artery-middle cerebral artery, TFCA : trans-femoral cerebral angiography, ICA : internal carotid artery, MTT : mean transit time, TTP : time to peak, SPECT : single photon emission computerized tomography.

• 

  Fig. 2 Comparison of preoperative and postoperative neurocognitive function tests in eight domains. Generally, postoperative function (in black) shows improvement compared to preoperative results except general mental status. Each error bar denotes standard deviation. GMS : general mental state, ATT : attention, ConfNa : confrontational naming, VisSpa : visuospatial function, VerMem : verbal memory, VisMem : visual memory, GenNA : generative naming, InhiCon : inhibitory control. Verbal memory and visual memory domain showed significant improvement (p-values=0.038 and p-values=0.042).

• 

  Fig. 3 Comparison of preoperative and postoperative memory domain based on time relationship shows improvement in both immediate recall and delayed recall. Each error bar denotes standard deviation. SNSB : Seoul Neuropsychological Screening Battery.

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