S-Space College of Medicine/School of Medicine (의과대학/대학원) Neurosurgery (신경외과학전공) Journal Papers (저널논문_신경외과학전공)
Prediction of the clinical outcome of pediatric moyamoya disease with postoperative basal/acetazolamide stress brain perfusion SPECT after revascularization surgery
- So, Young; Lee, Ho-Young; Kim, Seung-Ki; Lee, Jae Sung; Wang, Kyu-Chang; Cho, Byung-Kyu; Kang, Eunjoo; Lee, Dong Soo
- Issue Date
- American Heart Association
- Stroke. 2005 Jul;36(7):1485-9. Epub 2005 Jun 9.
- Acetazolamide/*pharmacology; Adolescent; Anticonvulsants/pharmacology; Brain/*pathology; Cerebral Angiography/methods; Cerebral Revascularization/*methods; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Moyamoya Disease/*pathology/*therapy; Perfusion; Prognosis; Regression Analysis; Stress, Physiological; Time Factors; Tomography, Emission-Computed, Single-Photon/*methods; Treatment Outcome
- BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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<0.001) were statistically significant. CONCLUSIONS: Basal/acetazolamide stress brain perfusion SPECT performed at 6 to 12 months after the indirect bypass operation could predict the further clinical outcome of pediatric patients with moyamoya disease. Patients with decreased cerebrovascular reserve will have remaining neurological deficit and ischemic attacks on follow-up.
- 1524-4628 (Electronic)