Effect of new combined revascularization surgery on cognitive function of adult patients with moyamoya disease

Abstract

Objective To explore the effect of new combined revascularization surgery on cognitive function in adult patients with moyamoya disease (MMD). Methods From May 2021 to April 2022, a total of 23 adult with MMD underwent superficial temporal artery (STA)⁃middle cerebral artery (MCA) bypass surgery and encephalo⁃duro⁃myo⁃arterio⁃periosto⁃synangosis (EDMAPS) at Aviation General Hospital were enrolled. They underwent head MRI, DSA and CT perfusion (CTP) examinations before and 6 months after surgery, and were graded for collateral compensation by the Matsushima grading system. Cognitive function was evaluated by Montreal Cognitive Assessment (MoCA) Beijing version. Results Total 23 patients had an increase in the MoCA total score (t=4.132, P=0.000), as well as the scores of visual space/executive ability (t=2.612, P=0.016), memory (t=5.144, P=0.000), attention (t=2.655, P=0.014) and directional ability (t=2.105, P=0.047). Based on the Matsushima grading system after surgery, there were 12 patients with grade A (>2/3 of MCA blood supply area), 8 with grade B (1/3-2/3 of MCA blood supply area), and 3 with grade C (<1/3 of MCA blood supply area). There was a statistically significant difference in the MoCA total score before and after surgery in patients with different Matsushima grading system (F=4.096, P=0.032). Further pairwise comparison showed that patients with Matsushima grade C had lower MoCA total score than that with grade B (t=2.715, P=0.018). There were 13 cases (56.52%) with postoperative cognitive function improvement (MoCA total score improvement rate≥12%), including 10 cases with Matsushima grade A, 2 with grade B, and one with grade C. The difference in cognitive function improvement rate among cases with different Matsushima grade was statistically significant (χ²=7.079, P=0.029), and only cognitive function improvement rate in Matsushima grade A was higher than that in grade B (Z=⁃2.543, P=0.011). Conclusions New combined revascularization surgery can effectively improve the cognitive function of adult patients with MMD, especially their visual space/executive ability, memory, attention and directional ability. The improvement of overall cognitive function is related to the range of collateral compensation after surgery.

doi：10.3969/j.issn.1672⁃6731.2023.04.015