Child's Nervous System

, Volume 20, Issue 5, pp 302–308 | Cite as

Determinants of intellectual outcome after surgical revascularization in pediatric moyamoya disease: a multivariate analysis

  • Satoshi KurodaEmail author
  • Kiyohiro Houkin
  • Tatsuya Ishikawa
  • Naoki Nakayama
  • Jun Ikeda
  • Nobuaki Ishii
  • Hiroyasu Kamiyama
  • Yoshinobu Iwasaki
Original Paper



The aim of this study was to clarify predictors for poor intellectual outcome in pediatric moyamoya disease.


Fifty-two pediatric patients were included. Clinical diagnosis was transient ischemic attacks (TIA) in 35 and completed stroke in 17. Ten patients underwent indirect synangiosis through “small craniotomy,” whereas the other 42 underwent superficial temporal artery (STA)–middle cerebral artery (MCA) anastomosis and indirect synangiosis through “large craniotomy.” Full-scale IQ (FSIQ) was measured using the Wechsler intelligence scale for children (WISC) after surgery. Multivariate logistic regression models were applied to test the effect of clinical factors on intellectual outcome.

Results and conclusion

Eight patients revealed mentally impaired status (FSIQ<70). Multivariate analysis revealed that completed stroke and “small craniotomy” surgery were significantly associated with poor intellectual outcome. Odds ratios of each factor were 33.4 (95% CI, 2.4–474) and 19.6 (95% CI, 1.8–215) respectively. Early diagnosis and the revascularization procedure over as wide an area as possible may be essential to improve their intellectual outcome.


Moyamoya disease Intellectual outcome Surgical revascularization Ischemia Cerebral blood flow 


  1. 1.
    Filley CM (2000) Clinical neurology and executive dysfunction. Semin Speech Lang 21:95–108CrossRefPubMedGoogle Scholar
  2. 2.
    Fukui M (1997) Current state of study on moyamoya disease in Japan. Surg Neurol 47:138–143CrossRefPubMedGoogle Scholar
  3. 3.
    Fukuyama Y, Umezu R (1985) Clinical and cerebral angiographic evolutions of idiopathic progressive occlusive disease of the circle of Willis (“moyamoya” disease) in children. Brain Dev 7:21–37PubMedGoogle Scholar
  4. 4.
    Houkin K, Aoki T, Takahashi A, Abe H (1994) Diagnosis of moyamoya disease with magnetic resonance angiography. Stroke 25:2159–2164PubMedGoogle Scholar
  5. 5.
    Houkin K, Kamiyama H, Takahashi A, Kuroda S, Abe H (1997) Combined revascularization surgery for childhood moyamoya disease: STA–MCA and encephalo-duro-arterio-myo-synangiosis. Childs Nerv Syst 13:24–29CrossRefPubMedGoogle Scholar
  6. 6.
    Houkin K, Kuroda S, Ishikawa T, Abe H (2000) Neovascularization (angiogenesis) after revascularization in moyamoya disease. Which technique is most useful for moyamoya disease? Acta Neurochir (Wien) 142:269–276Google Scholar
  7. 7.
    Ikezaki K, Matsushima T, Kuwabara Y, Suzuki SO, Nomura T, Fukui M (1994) Cerebral circulation and oxygen metabolism in childhood moyamoya disease: a perioperative positron emission tomography study. J Neurosurg 81:843–850PubMedGoogle Scholar
  8. 8.
    Imaizumi T, Hayashi K, Saito K, Osawa M, Fukuyama Y (1998) Long-term outcomes of pediatric moyamoya disease monitored to adulthood. Pediatr Neurol 18:321–325CrossRefPubMedGoogle Scholar
  9. 9.
    Imaizumi C, Imaizumi T, Osawa M, Fukuyama Y, Takeshita M (1999) Serial intelligence test scores in pediatric moyamoya disease. Neuropediatrics 30:294–299PubMedGoogle Scholar
  10. 10.
    Ishikawa T, Houkin K, Kamiyama H, Abe H (1997) Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease. Stroke 28:1170–1173Google Scholar
  11. 11.
    Isobe M, Kuroda S, Kamiyama H, Abe H, Mitumori K (1992) Cerebral blood flow reactivity to hyperventilation in children with spontaneous occlusion of the circle of willis (moyamoya disease). No Shinkei Geka 20:399–407PubMedGoogle Scholar
  12. 12.
    Karasawa J, Touho H, Ohnishi H, Miyamoto S, Kikuchi H (1992) Long-term follow-up study after extracranial–intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg 77:84–89PubMedGoogle Scholar
  13. 13.
    Kuroda S, Kamiyama H, Abe H, Yamauchi T, Kohama Y, Houkin K, Mitsumori K (1993) Cerebral blood flow in children with spontaneous occlusion of the circle of Willis (moyamoya disease): comparison with healthy children and evaluation of annual changes. Neurol Med Chir (Tokyo) 33:434–438Google Scholar
  14. 14.
    Kuroda S, Houkin K, Kamiyama H, Abe H, Mitsumori K (1995) Regional cerebral hemodynamics in childhood moyamoya disease. Childs Nerv Syst 11:584–590PubMedGoogle Scholar
  15. 15.
    Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H (2001) Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke 32:2110–2116PubMedGoogle Scholar
  16. 16.
    Kurokawa T, Tomita S, Ueda K, Narazaki O, Hanai T, Hasuo K, Matsushima T, Kitamura K (1985) Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children. Pediatr Neurol 1:274–277CrossRefPubMedGoogle Scholar
  17. 17.
    Matsushima Y, Aoyagi M, Masaoka H, Suzuki R, Ohno K (1990) Mental outcome following encephaloduroarteriosynangiosis in children with moyamoya disease with the onset earlier than 5 years of age. Childs Nerv Syst 6:440–443PubMedGoogle Scholar
  18. 18.
    Matsushima T, Inoue T, Suzuki SO, Fujii K, Fukui M, Hasuo K (1992) Surgical treatment of moyamoya disease in pediatric patients—comparison between the results of indirect and direct revascularization procedures. Neurosurgery 31:401–405PubMedGoogle Scholar
  19. 19.
    Matsushima Y, Aoyagi M, Nariai T, Takada Y, Hirakawa K (1997) Long-term intelligence outcome of post-encephalo-duro-arterio-synangiosis childhood moyamoya patients. Clin Neurol Neurosurg 99 [Suppl 2]:S147–S150Google Scholar
  20. 20.
    Miyamoto S, Akiyama M, Nagata I, Karasawa J, Nozaki K, Hashimoto N, Kikuchi H (1998) Long-term outcome after STA–MCA anastomosis for moyamoya disease. Neurosurg Focus 5:1–4Google Scholar
  21. 21.
    Ogawa A, Yoshimoto T, Suzuki J, Sakurai Y (1990) Cerebral blood flow in moyamoya disease. Part 1. Correlation with age and regional distribution. Acta Neurochir (Wien) 105:30–34Google Scholar
  22. 22.
    Sato H, Sato N, Tamaki N, Matsumoto S (1990) Chronic low-perfusion state in children with moyamoya disease following revascularization. Childs Nerv Syst 6:166–171PubMedGoogle Scholar
  23. 23.
    Suzuki J, Takaku A (1969) Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288–299PubMedGoogle Scholar
  24. 24.
    Takahashi A, Kamiyama H, Houkin K, Abe H (1995) Surgical treatment of childhood moyamoya disease—comparison of reconstructive surgery centered on the frontal region and the parietal region. Neurol Med Chir (Tokyo) 35:231–237Google Scholar
  25. 25.
    Touho H, Karasawa J, Ohnishi H (1996) Preoperative and postoperative evaluation of cerebral perfusion and vasodilatory capacity with 99mTc-HMPAO SPECT and acetazolamide in childhood moyamoya disease. Stroke 27:282–289PubMedGoogle Scholar
  26. 26.
    Wakai K, Tamakoshi A, Ikezaki K, Fukui M, Kawamura T, Aoki R, Kojima M, Lin Y, Ohno Y (1997) Epidemiological features of moyamoya disease in Japan: findings from a nationwide survey. Clin Neurol Neurosurg 99 [Suppl 2]:S1–S5Google Scholar
  27. 27.
    Wechsler D (1998) Manual for the Wechsler intelligence scale for children, 3rd edn (Japanese version). The Psychological Corporation, San AntonioGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Satoshi Kuroda
    • 1
    Email author
  • Kiyohiro Houkin
    • 1
  • Tatsuya Ishikawa
    • 1
  • Naoki Nakayama
    • 1
  • Jun Ikeda
    • 1
  • Nobuaki Ishii
    • 1
  • Hiroyasu Kamiyama
    • 1
  • Yoshinobu Iwasaki
    • 1
  1. 1.Department of NeurosurgeryHokkaido University Graduate School of MedicineKita-ku, Sapporo 060-8638Japan

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