Postoperative change of neuropsychological function after indirect revascularization in childhood moyamoya disease: a correlation with cerebral perfusion study

  • Yen-Hsuan Hsu
  • Ya-Fang Chen
  • Shih-Hung Yang
  • Chi-Cheng YangEmail author
  • Meng-Fai KuoEmail author
Original Article



The relationships between postoperative functional improvement in various cognitive domains and regional hemodynamic change have not been sufficiently studied in childhood moyamoya disease (MMD). The present study aimed to examine the cognitive benefit of indirect revascularization, the underlying biological mechanism, and factors affecting surgical outcome in childhood MMD.


Twenty-three patients with MMD aged under 20 years received neuropsychological examinations before and after indirect revascularization surgery, evaluating intellectual function, verbal and visual memory, and executive function. Among them, 13 patients had magnetic resonance perfusion (MRP) studies, in which regional cerebral perfusion was rated.


Postoperative improvement was observed in verbal memory performances (p = 0.02–0.03) and in cerebral perfusion at all 26 cerebral hemispheres (p = 0.003–0.005), especially in the middle cerebral artery (MCA) territories (p = 0.001–0.003). Hemodynamic improvement in the left MCA territories was significantly correlated with improvement of both verbal new learning (p = 0.01) and intellectual function (p = 0.004). Postoperative cognitive improvement of immediate recall and verbal intellectual function was associated with female sex (r = − 0.42) and symptom duration (p = − 0.03), respectively. Hemodynamic improvement in the MCA territories was related to longer follow-up intervals (p = 0.02).


The findings revealed that the selective postoperative cognitive improvement was associated with increased regional perfusion in the MCA territories, and indicate the importance of early intervention and the potential of indirect revascularization regarding long-term outcome.


Cerebral revascularization Stroke Hemodynamics Treatment outcome Moyamoya disease 



The authors thank the participants and their informants for the time and commitment to this research.

Author contribution

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yen-Hsuan Hsu, Ya-Fang Chen, Chie-Cheng Yang, and Meng-Fai Kuo. The first draft of the manuscript was written by Yen-Hsuan Hsu and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding information

This work was supported by the Ministry of Science and Technology [MOST 106-2314-B-194-001 and MOST 107-2314-B-002-077] and the Center for Innovative Research on Aging Society (CIRAS) from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by Ministry of Education (MOE) in Taiwan.

Compliance with ethical standards

This study was approved by the Research Ethics Committee of National Taiwan University Hospital (200910036R). All participants and/or their proxies signed written informed consent before entering the study.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyNational Chung Cheng UniversityChiayi CountyTaiwan
  2. 2.Center for Innovative Research on Aging Society (CIRAS)National Chung Cheng UniversityChiayi CountyTaiwan
  3. 3.Department of Medical ImagingNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Department of Medical ImagingNational Taiwan University Hospital Hsin-Chu BranchHsin-ChuTaiwan
  5. 5.Division of Neurosurgery, Department of SurgeryNational Taiwan University Hospital, National Taiwan University College of MedicineTaipeiTaiwan
  6. 6.Department of PsychologyNational Chengchi UniversityTaipeiTaiwan
  7. 7.Holistic Social Preventive and Mental Health CenterTaipei City HospitalTaipeiTaiwan

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