title: Determinants of intellectual outcome after surgical revascularization in pediatric moyamoya disease: a multivariate analysis.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan. skuroda@med.hokudai.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.forename: Jun
authors.initials: J
authors.lastname: Ikeda
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Ishii
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: 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