Revascularisation surgery improves cognition in adult patients with moyamoya disease

One-(2-18F-fluoro-1-(hydroxymethyl)ethoxy) methyl-2-nitroimidazole (18F-FRP170) is a marker of hypoxic but viable tissue in the human brain and is used in positron emission tomography (PET).1 Neural tissues showing elevated 18F-FRP170 uptake exist in brain areas with chronic cerebral ischaemia with a combination of increased oxygen extraction fraction, namely misery perfusion and moderately reduced cerebral metabolic rate of oxygen (CMRO2) due to atherosclerotic stenosis or occlusion of the internal carotid artery.1 These hypoxic neural tissues decrease after cerebral perfusion and restored following carotid endarterectomy, leading to postoperative cognitive improvement after surgery.2 Adults with ischaemic moyamoya disease (MMD) sometimes experience cognitive improvement after revascularisation surgery.3 The present prospective study was aimed to determine whether the resolution of hypoxia in neural tissue and recovery of cerebral oxygen metabolism on PET after revascularisation surgery such as a combination of the superficial temporal artery–middle cerebral artery anastomosis and encephalo-duro-myo-synangiosis are related to postoperatively improved cognition in adults with ischaemic MMD. Patients with the following criteria were prospectively included in this study: (1) bilateral MMD confirmed by angiography via arterial catheterisation; (2) histories of ischaemic symptoms in unilateral carotid artery territory ≤3 months before visiting our hospital; (3) ≥30 years and u003c60 years; (4) preoperative modified Rankin disability scale, 0 or 1; (5) no cortical infarct or presence of infarcts that did not occupy the entire cortical area …