Long-Term Cognitive Changes after Revascularization Surgery in Adult Patients with Ischemic Moyamoya Disease.
Long-Term Cognitive Changes after Revascularization Surgery in Adult Patients with Ischemic Moyamoya Disease.
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DOI：
10.1159/000521028
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发表时间：
2021
影响因子：
1.9
通讯作者：
Ogasawara K
中科院分区：
文献类型：
--
作者：
Uchida S;Kubo Y;Oomori D;Yabuki M;Kitakami K;Fujiwara S;Yoshida K;Kobayashi M;Terasaki K;Ogasawara K
以缺血为表现的成人烟雾病(MMD)的血运重建手术改变了认知功能，防止了进一步的脑缺血事件。然而，大多数研究在术后一年内重复进行神经心理学评估。我们先前对接受直接血管重建术的成年MMD患者进行的前瞻性队列研究显示，术后2个月分别有31%和44%的患者认知能力改善和下降。本前瞻性研究旨在通过对成年缺血性MMD脑血流灌注患者的跟踪观察，阐明直接血运重建术后5年认知功能的变化。总共有31名患者在直接血管重建术后进行了5年的前瞻性随访。分别于术前、术后2个月和5年随访结束时进行5种神经心理测试。采用脑血流灌注单光子发射计算机体层摄影术，分别于术前和术后5年随访结束时，测量患侧大脑半球相对于同侧小脑半球的脑血流量。根据术前和术后的神经心理测试结果，分别有11名、10名和10名患者在5年随访结束时认知功能改善，认知功能无变化，认知功能下降。这些比率与术后2个月(分别为10例、8例和13例患者的认知改善、认知功能无变化和认知下降)相比没有显著差异。尽管认知功能改善的患者在5年随访结束时大脑半球局部脑血流量显著高于手术前(80.7±6.1%比92.9±5.5%；p=0.0033)和认知功能无改变的患者(85.6±3.5vs.91.5±5.2%；p=0.0093)，但认知功能下降的患者在5年随访结束时这一值显著低于手术前(83.8±3.7vs.81.0±5.8%；P=0.0367)。在接受直接血管重建术的因缺血性MMD导致脑血流灌注困难的成年患者中，三分之一的患者在5年的随访结束时表现出认知改善，三分之一的患者表现出下降。与术前脑血流灌注相比，前一组患者和后一组患者在5年随访结束时，患侧大脑半球的脑血流量分别增加和减少。
Revascularization surgery for adult moyamoya disease (MMD) with ischemic presentation changes cognitive function and prevents further cerebral ischemic events. Most studies however repeated neuropsychological evaluation within 1 year after surgery. Our previous prospective cohort study of adult patients with MMD with misery perfusion who underwent direct revascularization surgery showed cognitive improvement and decline in 31% and 44%, respectively, of the patients 2 months after surgery. The present prospective study aimed to elucidate the 5-year cognitive changes after direct revascularization surgery in adult patients with cerebral misery perfusion due to ischemic MMD by following the same patients. In total, 31 patients were prospectively followed up for 5 years after direct revascularization surgery. Five types of neuropsychological tests were performed preoperatively, 2 months after surgery, and at the end of the 5-year follow-up. Cerebral blood flow (CBF) in the symptomatic cerebral hemisphere relative to that in the ipsilateral cerebellar hemisphere (hemispheric relative CBF [RCBF]) was measured using brain perfusion single-photon emission computed tomography preoperatively and at the end of the 5-year follow-up. Based on results of pre- and postoperative neuropsychological tests, 11, 10, and 10 patients showed cognitive improvement, no change in cognitive function, and cognitive decline, respectively, at the end of the 5-year follow-up. These ratios were not significantly different compared with those 2 months after surgery (cognitive improvement, no change in cognitive function, and cognitive decline in 10, 8, and 13 patients, respectively). Although hemispheric RCBF was significantly greater at the end of the 5-year follow-up than before surgery in patients with cognitive improvement (80.7 ± 6.1% vs. 92.9 ± 5.5%; p = 0.0033) and in those showing no change in cognitive function (85.6 ± 3.5 vs. 91.5 ± 5.2%; p = 0.0093), this value was significantly lower at the end of the 5-year follow-up than before surgery in patients with cognitive decline (83.8 ± 3.7 vs. 81.0 ± 5.8%; p = 0.0367). One-third of adult patients with cerebral misery perfusion due to ischemic MMD who underwent direct revascularization surgery exhibited cognitive improvement, and one-third exhibited decline at the end of the 5-year follow-up. The former and latter patients had increased and decreased CBF, respectively, in the affected cerebral hemisphere at the end of the 5-year follow-up compared with preoperative brain perfusion.
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DOI：
10.1038/jcbfm.2010.176
发表时间：
2011-03
期刊：
Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
影响因子：
--
作者：
通讯作者：
--
影响因子：
2.9
作者：
Nam, Ki-Woong;Cho, Won-Sang;Son, Young-Je
通讯作者：
Son, Young-Je
影响因子：
4.8
作者：
Ogasawara, K;Komoribayashi, N;Ogawa, A
通讯作者：
Ogawa, A
影响因子：
5.4
作者：
Seo WK;Kim JY;Choi EH;Kim YS;Chung JW;Saver JL;Bang OY;Kim GM
通讯作者：
Kim GM
影响因子：
2.6
作者：
Nishimiya, Masaki;Matsuda, Hiroshi;Sato, Noriko
通讯作者：
Sato, Noriko