Determinants of intellectual outcome after surgical revascularization in pediatric moyamoya disease: a multivariate analysis.
OBJECTIVE
The aim of this study was to clarify predictors for poor intellectual outcome in pediatric moyamoya disease.


METHODS
Fifty-two pediatric patients were included. Clinical diagnosis was transient ischemic attacks (TIA) in 35 and completed stroke in 17. Ten patients underwent indirect synangiosis through "small craniotomy," whereas the other 42 underwent superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis and indirect synangiosis through "large craniotomy." Full-scale IQ (FSIQ) was measured using the Wechsler intelligence scale for children (WISC) after surgery. Multivariate logistic regression models were applied to test the effect of clinical factors on intellectual outcome.


CONCLUSIONS
Eight patients revealed mentally impaired status (FSIQ<70). Multivariate analysis revealed that completed stroke and "small craniotomy" surgery were significantly associated with poor intellectual outcome. Odds ratios of each factor were 33.4 (95% CI, 2.4-474) and 19.6 (95% CI, 1.8-215) respectively. Early diagnosis and the revascularization procedure over as wide an area as possible may be essential to improve their intellectual outcome.
Kuroda
Satoshi
S
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan. skuroda@med.hokudai.ac.jp
Houkin
Kiyohiro
K
Ishikawa
Tatsuya
T
Nakayama
Naoki
N
Ikeda
Jun
J
Ishii
Nobuaki
N
Kamiyama
Hiroyasu
H
Iwasaki
Yoshinobu
Y
D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003399:Craniotomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D007360:Intelligence; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011184:Postoperative Period; D020521:Stroke / Q000209:etiology; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome; D014888:Wechsler Scales