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Neuropsychological impacts of indirect revascularization for pediatric moyamoya disease

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Abstract

Purpose

Moyamoya disease (MMD) commonly leads to neurocognitive impairment. This study was carried out to show that temporal encephaloduroarteriosynangiosis (EDAS) has a positive neuropsychological impact on pediatric MMD patients.

Methods

Fifty-five participants diagnosed with MMD from 2008 to 2014 were included in this retrospective study. The mean age at the preoperative evaluation was 9.5 years and the mean age at postoperative evaluation was 10.4. The average interval of initial and follow-up test was 10 months. K-WISC-III, Rey-Kim memory test, Children’s Color Trails test (CCTT), Wisconsin Card Sorting Test (WCST), and Advanced Test of Attention (ATA) were used to evaluate patient’s neurocognitive profile.

Results

In this study, preoperative and postoperative neuropsychological fields were compared. Prior operation, pediatric MMD patients showed 54.2% deficit of inattention but only around 2.5% deficit in verbal memory recall function. There was a significant increase of performance IQ and PO score component of PIQ improved almost 10 scores after surgery. For memorial function, there was an improvement of approximately 10 scores in MQ after the surgery. This study also showed parietal activation following surgical treatment which enhanced the ability to interpret visual materials, to register and to retrieve visual information. Interestingly, despite the parietal cover surgery, there was a significant improvement of performance on WCST and CCTT measuring the prefrontal executive function. Concerning failure to maintain set, no significant postoperative improvements were made. However, simple and selective visual attention on ATA was significantly improved postoperatively.

Conclusions

The results from neuropsychological field comparison testifies the effectiveness of temporal EDAS in pediatric MMD patients. The surgery not only enhances the blood flow in operative regions, but it also improves the broad cerebral function including frontoparietal domains. Such alteration leads to overall advancement in cognitive function which are impaired due to MMD.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea

    WooHyun Kim, Seong-eun Park, Eun-Kyung Park, Ju-Seong Kim, Dong-Seok Kim & Kyu-Won Shim

  2. Happience Psychology Clinic attached to Korea Jeail Psychiatric Clinic, Seoul, South Korea

    Eun-Young Lee

Authors
  1. WooHyun Kim
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  2. Eun-Young Lee
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  3. Seong-eun Park
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  4. Eun-Kyung Park
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  5. Ju-Seong Kim
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  6. Dong-Seok Kim
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Correspondence to Kyu-Won Shim.

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Kim, W., Lee, EY., Park, Se. et al. Neuropsychological impacts of indirect revascularization for pediatric moyamoya disease. Childs Nerv Syst 34, 1199–1206 (2018). https://doi.org/10.1007/s00381-018-3804-z

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  • DOI: https://doi.org/10.1007/s00381-018-3804-z

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