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Revascularisation surgery improves cognition in adult patients with moyamoya disease
  1. Toshihiko Ando1,2,
  2. Yasuyoshi Shimada1,2,
  3. Shunrou Fujiwara1,
  4. Kenji Yoshida1,
  5. Masakazu Kobayashi1,2,
  6. Yoshitaka Kubo1,
  7. Kazunori Terasaki2,
  8. Satoshi Ando1,
  9. Kuniaki Ogasawara1,2
  1. 1 Department of Neurosurgery, Iwate Medical University, Morioka, Japan
  2. 2 Cyclotron Research Center, Iwate Medical University, Morioka, Japan
  1. Correspondence to Professor Kuniaki Ogasawara, Neurosurgery, Iwate Medical University, Morioka 020-8505, Japan; kuogasa{at}

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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.

Materials and methods

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 <60 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 …

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  • Contributors TA and KO: guarantor of integrity of the entire study. KO: study concepts. TA, MK and KO: study design. TA, MK and KY: literature research. TA, YS, SF, YK, KT, SA and KY: data acquisition. SF, YK, KT and SA: data analysis. TA, KO and KY: manuscript preparation. SF, YK and KT: manuscript editing.

  • Funding This study was funded by Scientific Research from Japan Society for the Promotion of Science (grant number: JP18K09002) and Grant-in-Aid for Strategic Medical Science Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (grant number: S1491001, 2014–2018).

  • Competing interests The corresponding author (KO) declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: Consigned research funds from Nihon Medi-Physics Co., Ltd.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.