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Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Adult patients with moyamoya disease (MMD) occasionally exhibit cerebral hyperperfusion after arterial bypass surgery, leading to persistent cognitive decline. The present supplementary analysis of a prospective 5-year cohort study aimed to determine whether cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD causes cerebral atrophy, and whether the development of cerebral atrophy is related to persistent cognitive decline.

Methods

In total, 31 patients who underwent arterial bypass surgery also underwent fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and neuropsychological testing before surgery and at the end of a 5-year follow-up. The development of cerebral hyperperfusion and hyperperfusion syndrome after surgery was defined based on brain perfusion single-photon emission computed tomography (SPECT) findings and clinical symptoms. Univariate and multivariate logistic regression analyses of factors related to the development of cerebral atrophy on FLAIR MRI or cognitive decline on neuropsychological testing at the end of the 5-year follow-up were performed.

Results

Eleven patients (35%) developed cerebral atrophy in the frontal lobe where the superficial temporal artery was anastomosed. Cerebral hyperperfusion on brain perfusion SPECT (odds ratio [OR], 50.6; p = 0.0008) or cerebral hyperperfusion syndrome (OR, 41.8; p = 0.0026) was independently associated with the development of cerebral atrophy, and cerebral atrophy development was significantly associated with cognitive decline (OR, 47.7; p = 0.0010).

Conclusions

Cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD can cause cerebral atrophy related to persistent cognitive decline.

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Data availability

All data generated or analyzed during this study are not publicly available on ethical grounds. However, inquiries regarding these data can be directed to the corresponding author.

Code availability

Not applicable.

Abbreviations

MMD:

Moyamoya disease

FLAIR:

Fluid-attenuated inversion recovery

MRI:

Magnetic resonance imaging

SPECT:

Single-photon emission computed tomography

CI:

Confidence interval

CBF:

Cerebral blood flow

MCA:

Middle cerebral artery

PET:

Positron emission tomography

WAIS-R:

Wechsler Adult Intelligence Scale-Revised

IQ:

Intelligence quotient

WMS:

Wechsler Memory Scale

MQ:

Memory quotient

Rey test:

Rey–Osterrieth Complex Figure test

CHS:

Cerebral hyperperfusion syndrome

ACH:

Asymptomatic cerebral hyperperfusion

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Funding

This work was supported in part by Grants-in-Aids for Scientific Research KAKEN from the Japan Society for the Promotion of Science (21K09108 and 21K09157) and from the National Hospital Organization Kamaishi Hospital KENKYUHI.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Idaidoori Yahaba-cho, Shiwa-gun, Iwate, 020-3695, Japan

    Yasukazu Katakura, Yoshitaka Kubo, Kazumasa Dobashi, Kazuto Kimura, Shunrou Fujiwara, Kohei Chida, Masakazu Kobayashi, Kenji Yoshida & Kuniaki Ogasawara

  2. Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Iwate, Japan

    Kazunori Terasaki

Authors
  1. Yasukazu Katakura
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  2. Yoshitaka Kubo
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  3. Kazumasa Dobashi
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  4. Kazuto Kimura
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Contributions

Yasukazu Katakura: conception and design, acquisition of data, analysis and interpretation of data; drafting the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Yoshitaka Kubo: conception and design; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Kazumasa Dobashi: conception and design; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Kazuto Kimura: acquisition of data; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Shunrou Fujiwara: conception and design; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Kohei Chida: conception and design; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Masakazu Kobayashi: conception and design; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Kenji Yoshida: conception and design; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Kazunori Terasaki: acquisition of data; revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Kuniaki Ogasawara: conception and design, acquisition of data, analysis and interpretation of data; drafting the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Kuniaki Ogasawara.

Ethics declarations

Ethical approval

All procedures in this study were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by our institutional ethics committee. Written, informed consent was obtained from all patients or their next of kin prior to participation in the original study.

Consent to participate

Each patient provided written informed consent prior to participation.

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Each patient provided written informed consent prior to publication.

Competing interests

The author (Kuniaki Ogasawara) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Consigned research funds from Nihon Medi-Physics Co., Ltd.

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This article is part of the Topical Collection on Vascular Neurosurgery—Ischemia.

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Katakura, Y., Kubo, Y., Dobashi, K. et al. Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort. Acta Neurochir 164, 1037–1045 (2022). https://doi.org/10.1007/s00701-022-05141-w

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