Prediction of the clinical outcome of pediatric moyamoya disease with postoperative basal/acetazolamide stress brain perfusion SPECT after revascularization surgery

• Published in: Stroke (1970) 2005-07, Vol.36 (7), p.1485-1489
• Main Authors: SO, Young, LEE, Ho-Young, KIM, Seung-Ki, JAE SUNG LEE, WANG, Kyu-Chang, CHO, Byung-Kyu, KANG, Eunjoo, DONG SOO LEE
• Format: Article
• Language: English
• Subjects: Acetazolamide - pharmacology; Adolescent; Anticonvulsants - pharmacology; Biological and medical sciences; Brain - pathology; Cerebral Angiography - methods; Cerebral Revascularization - methods; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Moyamoya Disease - pathology; Moyamoya Disease - therapy; Nervous system; Neurology; Perfusion; Prognosis; Regression Analysis; Stress, Physiological; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Tomography, Emission-Computed, Single-Photon - methods; Treatment Outcome; Ultrasonic investigative techniques; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000170709.95185.b1

We evaluated whether basal/acetazolamide stress brain perfusion SPECT performed after revascularization surgery can predict the further clinical outcome of patients with pediatric moyamoya disease. A total of 77 (31 males, 46 females, age 6.6+/-3.2 years) patients with postoperative pediatric moyamoya disease who underwent basal/acetazolamide stress brain perfusion SPECT 6 to 12 months after revascularization surgery and who were followed-up >12 months after SPECT were included. Mean follow-up period after SPECT was 36+/-19 months. Sixty-two patients underwent bilateral ribbon encephaloduroarteriosynangiosis (EDAS), 14 bilateral EDAS, and 1 unilateral EDAS. Ordinal logistic regression analysis using 5 independent variables (infarction on preoperative MRI, age at the first operation, highest Suzuki stage on cerebral angiography, and regional cerebrovascular reserve on postoperative SPECT) against postoperative clinical outcomes was performed. Fifty-one patients had preserved reserve on postoperative SPECT and their clinical outcomes were excellent (30), good (15), fair (4), and poor (2); 26 patients had decreased reserve (excellent, 1; good, 7; fair, 14; poor, 4). On ordinal logistic regression analysis, age at the first operation (P=0.033) and reserve on postoperative SPECT (P