Post-Surgical Cognitive Outcomes of Moyamoya Disease: A Systematic Review.

Autor: Mitchell DL; Division of Pediatric Neurosurgery, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, Chicago, Illinois, USA., Shlobin NA; Division of Pediatric Neurosurgery, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, Chicago, Illinois, USA., LoPresti MA; Division of Pediatric Neurosurgery, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, Chicago, Illinois, USA., Scoville JP; Division of Pediatric Neurosurgery, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, Chicago, Illinois, USA., Winterhalter E; Division of Pediatric Neurosurgery, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, Chicago, Illinois, USA., Lam S; Division of Pediatric Neurosurgery, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, Chicago, Illinois, USA. Electronic address: sandilam@gmail.com.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2023 Oct; Vol. 178, pp. 181-190.e1. Date of Electronic Publication: 2023 Jul 26.
DOI: 10.1016/j.wneu.2023.07.099
Abstrakt: Background: Moyamoya disease (MMD) is an occlusive arteriopathy leading to stroke. Progressive if left untreated, revascularization surgery has become the mainstay of treatment. Although clinical and radiographic outcomes of MMD after intervention are well-characterized, cognitive outcomes in pediatric patients remain unclear. We aimed to examine postoperative cognitive outcomes in children with MMD, examine factors associated with cognitive changes after intervention, and define the effect of revascularization surgery on cognitive outcomes.
Methods: A systematic review was conducted following PRISMA guidelines searching PubMed, Embase, and Scopus databases. Articles met inclusion criteria if they studied pediatric patients undergoing revascularization surgery for MMD and examined cognitive outcomes either qualitatively or quantitatively. All data extracted from included articles was examined descriptively.
Results: Of 1091 resultant articles, 12 articles containing 446 patients were included. Surgery was associated with maintained or improved full scale intellectual quotient (IQ), performance IQ, perceptual IQ, memory quotient and verbal memory. However, 70% of patients had impaired cognitive function, with associated poor school performance. Improvements in cognition were associated with increased cerebral blood flow, particularly to the middle cerebral artery, due to the development of collaterals. Female sex, shorter duration from symptom onset to surgery, and surgery after age 7 were predictive of cognitive improvement. Completed ischemic stroke prior to surgery was associated with poorer cognitive outcomes.
Conclusions: Although children with MMD have improved cognitive outcomes following revascularization overall, a distinct subset experience cognitive impairment. Consideration of patient-specific and treatment-related factors is important to enable proper risk stratification and inform management approaches.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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