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Yabuki M, Kubo Y, Kitakami K, Oomori D, Fujiwara S, Yoshida K, Kobayashi M, Ogasawara K. Development of cerebral microbleeds and its impact on cognitive function in adult patients receiving medical management alone for ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort. Neurol Res 2022; 44:1104-1112. [PMID: 35975947 DOI: 10.1080/01616412.2022.2112375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE De novo cerebral microbleeds (CMBs) on T2*-weighted magnetic resonance imaging (MRI) develop over time in adult moyamoya disease (MMD) and are generally associated with a decline in global cognitive function. The present supplementary analysis of a 5-year prospective cohort aimed to elucidate the incidence of an interval increase in CMBs in adult patients receiving medical management alone for ischemic MMD and its impact on cognitive function. METHODS Sixty-four patients without misery perfusion in the symptomatic cerebral hemispheres at inclusion who did not experience any further ischemic symptoms or new hemorrhagic events during a 5-year follow-up period underwent T2*-weighted MRI and five kinds of neuropsychologic tests at inclusion and the end of the 5-year follow-up. RESULTS When T2*-weighted MRI was compared between inclusion and the end of the 5-year follow-up, 10 patients (15%) had an interval increase in CMBs in the symptomatic cerebral hemisphere at inclusion. The scores from two kinds of neuropsychologic tests significantly deteriorated at the end of the 5-year follow-up compared with those at inclusion in patients with an interval increase in CMBs, whereas the scores of four kinds of neuropsychologic tests significantly improved at the end of the 5-year follow-up compared with those at inclusion in patients without interval increases in CMBs, asymptomatic ischemic lesions, or angiographic disease progression. CONCLUSIONS The incidence of an interval increase in CMBs was 15% per 5 years in adult patients receiving medical management alone for ischemic MMD, and this increase was associated with a decline in cognitive decline.
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Affiliation(s)
- Masahiro Yabuki
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kei Kitakami
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Daisuke Oomori
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
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Uchida S, Kubo Y, Oomori D, Yabuki M, Kitakami K, Fujiwara S, Yoshida K, Kobayashi M, Terasaki K, Ogasawara K. Long-Term Cognitive Changes after Revascularization Surgery in Adult Patients with Ischemic Moyamoya Disease. Cerebrovasc Dis Extra 2021; 11:145-154. [PMID: 34808627 PMCID: PMC8787508 DOI: 10.1159/000521028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Revascularization surgery for adult moyamoya disease (MMD) with ischemic presentation changes cognitive function and prevents further cerebral ischemic events. Most studies however repeated neuropsychological evaluation within 1 year after surgery. Our previous prospective cohort study of adult patients with MMD with misery perfusion who underwent direct revascularization surgery showed cognitive improvement and decline in 31% and 44%, respectively, of the patients 2 months after surgery. The present prospective study aimed to elucidate the 5-year cognitive changes after direct revascularization surgery in adult patients with cerebral misery perfusion due to ischemic MMD by following the same patients. Methods In total, 31 patients were prospectively followed up for 5 years after direct revascularization surgery. Five types of neuropsychological tests were performed preoperatively, 2 months after surgery, and at the end of the 5-year follow-up. Cerebral blood flow (CBF) in the symptomatic cerebral hemisphere relative to that in the ipsilateral cerebellar hemisphere (hemispheric relative CBF [RCBF]) was measured using brain perfusion single-photon emission computed tomography preoperatively and at the end of the 5-year follow-up. Results Based on results of pre- and postoperative neuropsychological tests, 11, 10, and 10 patients showed cognitive improvement, no change in cognitive function, and cognitive decline, respectively, at the end of the 5-year follow-up. These ratios were not significantly different compared with those 2 months after surgery (cognitive improvement, no change in cognitive function, and cognitive decline in 10, 8, and 13 patients, respectively). Although hemispheric RCBF was significantly greater at the end of the 5-year follow-up than before surgery in patients with cognitive improvement (80.7 ± 6.1% vs. 92.9 ± 5.5%; p = 0.0033) and in those showing no change in cognitive function (85.6 ± 3.5 vs. 91.5 ± 5.2%; p = 0.0093), this value was significantly lower at the end of the 5-year follow-up than before surgery in patients with cognitive decline (83.8 ± 3.7 vs. 81.0 ± 5.8%; p = 0.0367). Conclusion One-third of adult patients with cerebral misery perfusion due to ischemic MMD who underwent direct revascularization surgery exhibited cognitive improvement, and one-third exhibited decline at the end of the 5-year follow-up. The former and latter patients had increased and decreased CBF, respectively, in the affected cerebral hemisphere at the end of the 5-year follow-up compared with preoperative brain perfusion.
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Affiliation(s)
- Shun Uchida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Daisuke Oomori
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masahiro Yabuki
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kei Kitakami
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kazunori Terasaki
- Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
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Oomori D, Kubo Y, Yabuki M, Kitakami K, Fujiwara S, Yoshida K, Kobayashi M, Terasaki K, Ogasawara K. Angiographic disease progression in medically treated adult patients with ischemic moyamoya disease without cerebral misery perfusion: supplementary analysis of a 5-year prospective cohort. Neurosurg Rev 2021; 45:1553-1561. [PMID: 34689243 DOI: 10.1007/s10143-021-01677-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
Angiographic disease progression reportedly develops in adult moyamoya disease (MMD). However, more than half of patients analyzed underwent revascularization surgery. The present supplementary analysis of a 5-year prospective cohort with follow-up using magnetic resonance angiography (MRA) and cerebral blood flow (CBF) measurements was to elucidate the incidence and clinical features of angiographic disease progression in adult patients receiving medical management alone for ischemic MMD. Sixty-eight patients without misery perfusion in the symptomatic cerebral hemispheres underwent MRA and CBF measurement using brain perfusion single-photon emission computed tomography at inclusion and at the end of the 5-year follow-up. When neurological symptoms recurred or newly developed during the 5-year follow-up period, additional MRA and CBF measurements were also performed at that time. All four patients with further ischemic events during the 5-year follow-up period exhibited angiographic disease progression on MRA at such events. Of the remaining 64 patients without further events during the 5-year follow-up period, four exhibited angiographic disease progression on MRA at the end of the 5-year follow-up. CBF was significantly lower at the time of further ischemic events or at the end of the 5-year follow-up than at inclusion in eight patients with angiographic disease progression (p = 0.0117). The incidence of angiographic disease progression was 12% for 5 years in medically treated adult patients with ischemic MMD without cerebral misery perfusion. Patients with further ischemic events always exhibited angiographic disease progression. Cerebral perfusion was reduced in patients with angiographic disease progression even when further ischemic events did not occur.
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Affiliation(s)
- Daisuke Oomori
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Masahiro Yabuki
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Kei Kitakami
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan.,Institute for Biomedical Sciences, School of Medicine, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Kazunori Terasaki
- Institute for Biomedical Sciences, School of Medicine, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan. .,Institute for Biomedical Sciences, School of Medicine, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan.
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Kitakami K, Kubo Y, Yabuki M, Oomori D, Takahashi T, Igarashi S, Fujiwara S, Yoshida K, Kobayashi M, Terasaki K, Ogasawara K. Five-Year Outcomes of Medical Management Alone for Adult Patients with Ischemic Moyamoya Disease without Cerebral Misery Perfusion. Cerebrovasc Dis 2021; 51:158-164. [PMID: 34518462 DOI: 10.1159/000518725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION No clear guidelines for treating adult patients with ischemic moyamoya disease (MMD) without cerebral hemodynamic compromise such as misery perfusion have been established. Our previous prospective cohort study of adult patients with MMD without misery perfusion who were treated with medical management alone, including an antiplatelet drug, showed a recurrent ischemic event rate of 3% per 2 years. The present prospective study aimed to elucidate the 5-year clinical, cerebral perfusion, and cognitive outcomes of medical management alone for Japanese adult patients with ischemic MMD without cerebral misery perfusion by following the same patients for another 3 years. METHODS In total, 68 patients without recurrent events at a 2-year follow-up were prospectively followed up for another 3 years. Cerebral blood flow (CBF) in the symptomatic cerebral hemisphere was measured using brain perfusion single-photon emission computed tomography at inclusion and at the end of the subsequent 3-year follow-up. Neuropsychological testing was performed at inclusion and at the end of the initial 2- and subsequent 3-year follow-ups. RESULTS During the subsequent 3-year follow-up, 2 patients (3%) developed further ischemic events. In patients without further ischemic events, CBF was significantly greater at the end of the subsequent 3-year follow-up than at inclusion (p = 0.0037), and all neuropsychological test scores improved or remained unchanged at the end of initial 2- and subsequent 3-year follow-ups compared with that at inclusion. CONCLUSION In adult patients receiving medical management alone for ischemic MMD without cerebral misery perfusion, the incidence of further ischemic events was 6% per 5 years and did not change between the initial 2 years after the last is-chemic event and the subsequent 3 years. In patients without further ischemic events, CBF and cognitive function had not deteriorated at 5 years after the last ischemic event.
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Affiliation(s)
- Kei Kitakami
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masahiro Yabuki
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Daisuke Oomori
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Tatsuhiko Takahashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Suguru Igarashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kazunori Terasaki
- Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
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Hiraoka K, Nasu M, Minamitsu A, Shimizu A, Oomori D, Yamabe S. Experimental and Theoretical Studies of Gas-Phase Ion/Molecule Reactions in SiF4 Forming SiFm+(SiF4)n Clusters (m = 0−3 and n = 0−2). J Phys Chem A 1999. [DOI: 10.1021/jp983253b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kenzo Hiraoka
- Faculty of Engineering, Yamanashi University, Takeda-4, Kofu 400-8511, Japan
| | - Masayuki Nasu
- Faculty of Engineering, Yamanashi University, Takeda-4, Kofu 400-8511, Japan
| | - Akihito Minamitsu
- Faculty of Engineering, Yamanashi University, Takeda-4, Kofu 400-8511, Japan
| | - Akitaka Shimizu
- Faculty of Engineering, Yamanashi University, Takeda-4, Kofu 400-8511, Japan
| | - Daisuke Oomori
- Faculty of Engineering, Yamanashi University, Takeda-4, Kofu 400-8511, Japan
| | - Shinichi Yamabe
- Department of Chemistry, Nara University of Education, Takabatake-cho, Nara 630-8528, Japan
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