Evaluation Of Clinical Features And Surgical Efficacy With Hemodynamic In Young MMD

Objective Moyamoya disease is a cerebrovascular disease characterized by chronic stenosis and occlusion of intracranial arteries,as well as compensatory proliferation of smoky blood vessels in the skull base.This disease mainly occurs in East Asia,the children and young adults are the main populations of Moyamoya disease.There has been little research on this disease in the past.In recent years,with the advancement of imaging technology,the prevalence of this disease has increased greatly,which has been received more attention.Compared with other age groups,young adults(18-45 years old),as the main productivity of society,have a greater impact on society and family.However,the characteristics of the youth with moyamoya disease are rarely described.This study first enrolled young patients with moyamoya disease aged 18 to 45 years old,and collected and compared the differences in clinical and imaging characteristics among patients with cerebral infarction,cerebral hemorrhage,and no stroke.The aim was to explore the clinical characteristics and stroke risk factors of moyamoya disease in young people.Secondly,we applied arterial spin labeling(ASL)technology to evaluate the hemodynamic characteristics of enrolled young non-stroke moyamoya disease patients and analyze various cognitive aspects of patients.We hope to clarify the correlation between cognitive function and hypoperfusion in moyamoya disease patients.Finally,this study used ASL technology to evaluate the hemodynamic changes of enrolled patients after surgery,which was also compared with the gold standard for angiography evaluation,in order to find a non-invasive quantitative method for evaluating the effectiveness of vascular revascularization.Method A total of 510 patients with moyamoya disease aged 18-45 years who were admitted to the neurosurgery Department of the Fifth Medical Center of the PLA General Hospital from January 2018 to December 2020 were retrospectively included,those patients were divided into stroke group(infarction group and hemorrhage group)and non-stroke control group.Clinical and imaging data were collected and analyzed,and we use multivariate logistic regression analysis to explore the risk factors of ischemic stroke and hemorrhagic stroke in young patients with Moyamoya disease respectively.Subsequently,57 young asymptomatic MMD patients who were initially admitted to our hospital between January 2021 and December 2021 were prospectively included.And 30 young people matched with the age,gender,and education level at our hospital’s health examination center were used as the health control group.We collected ASL perfusion data and applied post-processing software to obtain perfusion maps of multiple brain regions,analyzed the cognitive function and perfusion characteristics of young non-stroke MMD patients.And Spearman correlation analysis was used to explore the correlation between cognitive dysfunction and perfusion in various regions of interest.According to the gold standard for evaluating postoperative collateral compensation using angiography(Matsushima stage),we evaluated the consistency between angiography and ASL technology for surgical efficacy,and used ASL data to evaluate the improvement of cerebral blood flow perfusion and cognitive function in enrolled patients.Results Among 510 young patients with moyamoya disease(female 246),there were no significant differences in sex,smoking,drinking,anemia,hyperhomocysteinemia and hyperuricemia in stroke group(262 cases),hemorrhage group(72 cases)and control group(176 cases).Multivariate logistic regression analysis showed that dilatation of the anterior choroidal artery or posterior communicating artery(ACh A-PCom A)and age were independent risk factors for the occurrence of cerebral hemorrhage.Family history of moyamoya disease / stroke,hyperlipidemia,diabetes mellitus,thyroid dysfunction,and posterior communicating artery(PCA)stenosis were independent risk factors for infarction,with a higher MMD collateral circulation score(MCGS)being the only protective factor found.In a total of 41(71.93%)of young MMD compared with the healthy group,the MOCA score(P <0.001)executive function TMTB(P <0.001),short memory(P=0.008),visual spatial ability(CDT),and verbal Boston named BNT(P=0.031)decreased in universal areas of interest,with differences in bilateral caudate nucleus,left M1,and bilateral M4-M6.In the correlation analysis of perfusion and cognitive function in the case group,it was found that executive dysfunction may be related to the decline in ASL-CBF in ROI in the frontal,temporal-occipital and limbic system,instantaneous memory may be related to ASL-CBF decline in ROI in the frontal and temporal lobe in the dominant hemisphere,and delayed memory may be related to CBF in ROI in the frontal,temporal,parietal and limbic system,and language expression may be related to CBF decline in the posterior orbital frontal cortex in the dominant hemisphere;no interest related to the clock drawing test was found.The improvement in cognitive function and ASL-CBF were statistically significant in young MMD patients without stroke.ASL and DSA agreed well for revascularization(k=0.353,P=0.003).Conclusion Cerebral infarction was the main stroke type in young MMD patients.The risk factors of cerebral hemorrhage and cerebral infarction were different in young patients with moyamoya disease.Young patients with MMD complicated with diabetes,thyroid dysfunction,hyperlipidemia,PCA stenosis,and family history of moyamoya disease / stroke were more likely to have cerebral infarction.Age and the presence of dilated ACh A-PCom A young patients with moyamoya disease were more likely to develop cerebral hemorrhage.There was a higher incidence of cognitive dysfunction in young apoplectic moyamoya patients.The decline of cognitive function was related to the decrease of cerebral blood perfusion in the dominant hemispherical regions of interest,and the decrease of perfusion in different brain regions will lead to the decrease of scores in different cognitive domains.Cerebral hemodynamics and cognitive function scores can be improved by revascularization surgery in young apoplectic moyamoya disease patients with cognitive dysfunction.