Improvement in cognitive decline after indirect bypass surgery in adult moyamoya disease: implication of 15O-gas positron emission tomography
Improvement in cognitive decline after indirect bypass surgery in adult moyamoya disease: implication of 15O-gas positron emission tomography
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DOI：
10.1007/s12149-020-01473-8
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发表时间：
2020-05-06
影响因子：
2.6
通讯作者：
Nariai, Tadashi
中科院分区：
文献类型：
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作者：
Hara, Shoko;Kudo, Takumi;Nariai, Tadashi
目的通过分析O-15气体正电子发射断层扫描(PET)的血流动力学和代谢参数，探讨烟雾病(MMD)患者搭桥术后认知功能减退改善的特点。材料与方法我们回顾分析了成人MMD患者在间接搭桥手术前和术后一年左右进行的PET和认知测试。对认知功能下降有改善和无改善的患者进行左侧罗兰迪区的PET参数比较。结果在分析的19例患者中，14例(74%)的言语智商或操作智商(VIQ或PIQ)有改善。四分之三的围手术期脑梗塞患者经历了明显的认知能力下降。认知功能减退有改善的患者术前氧摄取分数(OEF)显著高于无改善的患者(P=0.03)。认知功能减退有改善的患者术后脑氧代谢率(CMRO2)增加明显高于无改善的患者(P=0.02)。结论成人MMD患者如果术前局部OEF明显升高，术后局部CMRO2明显升高，则手术成功后认知功能减退可能得到改善。
Purpose To investigate the characteristics of patients with moyamoya disease (MMD) who show improvement in their cognitive decline after bypass surgery by analyzing the hemodynamic and metabolic parameters of O-15-gas positron emission tomography (PET). Materials and methods We retrospectively analyzed adult patients with MMD who were evaluated with PET and cognitive tests before and approximately one year after indirect bypass surgery. The PET parameters of the left Rolandic area were compared between patients who did and did not show improvement in their cognitive decline. Results Of the 19 patients analyzed, fourteen (74%) showed improvement in either the verbal or performance intelligence quotient (VIQ or PIQ). Three out of four patients with perioperative infarction experienced significant cognitive decline. The preoperative oxygen extraction fraction (OEF) was significantly higher in patients who showed improvement in their cognitive decline in terms of the PIQ than in those patients who did not (P = 0.03). The postoperative increase in the cerebral metabolic rate of oxygen (CMRO2) was significantly higher in patients who showed improvement in their cognitive decline in terms of the VIQ than in those who did not (P = 0.02). Conclusion Adult patients with MMD might show improvement in their cognitive decline after successful indirect bypass surgery if they have a severely increased regional OEF before the surgery and an increased regional CMRO2 after the surgery.