Clinical Outcome, Cognition, and Cerebrovascular Reactivity after Surgical Treatment for Moyamoya Vasculopathy: A Dutch Prospective, Single-Center Cohort Study

Pieter Thomas Deckers*, Annick Kronenburg, Esther van den Berg, Monique M. van Schooneveld, Evert Jan P.A. Vonken, Willem M. Otte, Bart N.M. van Berckel, Maqsood Yaqub, Catharina J.M. Klijn, Albert van der Zwan, Kees P.J. Braun

*Corresponding author for this work

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Abstract

Background: It remains unclear whether revascularization of moyamoya vasculopathy (MMV) has a positive effect on cognitive function. In this prospective, single-center study, we investigated the effect of revascularization on cognitive function in patients with MMV. We report clinical and radiological outcome parameters and the associations between clinical determinants and change in neurocognitive functioning. Methods: We consecutively included all MMV patients at a Dutch tertiary referral hospital who underwent pre- and postoperative standardized neuropsychological evaluation, [15O]H2O-PET (including cerebrovascular reactivity (CVR)), MRI, cerebral angiography, and completed standardized questionnaires on clinical outcome and quality of life (QOL). To explore the association between patient characteristics, imaging findings, and change in the z-scores of the cognitive domains, we used multivariable linear- and Bayesian regression analysis. Results: We included 40 patients of whom 35 (27 females, 21 children) were treated surgically. One patient died after surgery, and two withdrew from the study. TIA- and headache frequency and modified Rankin scale (mRS) improved (resp. p = 0.001, 0.019, 0.039). Eleven patients (seven children) developed a new infarct during follow-up (31%), five of which were symptomatic. CVR-scores improved significantly (p < 0.0005). The language domain improved (p = 0.029); other domains remained stable. In adults, there was an improvement in QOL. We could not find an association between change in imaging and cognitive scores. Conclusion: In this cohort of Western MMV patients, TIA frequency, headache, CVR, and mRS improved significantly after revascularization. The language domain significantly improved, while others remained stable. We could not find an association between changes in CVR and cognitive scores.

Original languageEnglish
Article number7427
JournalJournal of Clinical Medicine
Volume11
Issue number24
DOIs
Publication statusPublished - 14 Dec 2022

Bibliographical note

Funding Information:
This work was supported by the Dutch Brain Foundation ((2012(1)-179); the Christine Bader Fund Irene Children’s Hospital); the Tutein Nolthenius Oldenhof Fund, the Johanna Children Fund; Friends of the Wilhelmina Children’s Hospital; and the Brain Technology Institute Foundation.

Publisher Copyright:
© 2022 by the authors.

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