title: Effects of surgical revascularization on cerebral oxygen metabolism in patients with Moyamoya disease: an 15O-gas positron emission tomographic study.
abstract: OBJECTIVE
  This prospective study was aimed to evaluate the effects of surgical revascularization on cerebral oxygen metabolism in moyamoya disease.
  
  
  METHODS
  This study included totally 69 hemispheres of 42 patients who underwent superficial temporal artery to middle cerebral artery anastomosis and indirect bypass for moyamoya disease between 2000 and 2011. There were 12 children and 30 adults. MRI and (15)O-gas positron emission tomography were performed before and 3 to 4 months after surgery. Hemodynamic and metabolic parameters were precisely quantified and statistically analyzed.
  
  
  RESULTS
  Preoperative positron emission tomographic scans revealed that cerebral blood flow was decreased, cerebral blood volume was increased, and cerebral metabolic rate for oxygen was decreased in both pediatric and adult patients. Cerebral metabolic rate for oxygen reduction was observed in ≈80% of pediatric (16/21; 76%) and adult hemispheres (38/48; 79%). Surgical revascularization resolved hemodynamic compromise in all operated hemispheres. Cerebral metabolic rate for oxygen significantly improved in pediatric patients without parenchymal lesions (n=8), but not those with parenchymal lesions (n=8). Multivariate analysis revealed that cerebral metabolic rate for oxygen significantly improved in younger adult patients without parenchymal lesions (P=0.0264; odds ratio, 0.88; 95% confidence interval, 0.79-0.99).
  
  
  CONCLUSIONS
  Cerebral oxygen metabolism is significantly depressed in ≈80% of the involved hemispheres of moyamoya disease and improves in pediatric and younger adult patients without parenchymal lesions after bypass surgery. Cerebral oxygen metabolism may be reversibly depressed in response to cerebral ischemia in them although the underlying mechanisms are still unclear.
authors.affiliation: From the Departments of Neurosurgery (S.K., D.K., K. Houkin) and Nuclear Medicine (K. Hirata, T.S., N.T.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan (S.K., D.K.). skuroda@med.u-toyama.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.affiliation: From the Departments of Neurosurgery (S.K., D.K., K. Houkin) and Nuclear Medicine (K. Hirata, T.S., N.T.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan (S.K., D.K.).
authors.forename: Daina
authors.initials: D
authors.lastname: Kashiwazaki
authors.affiliation: From the Departments of Neurosurgery (S.K., D.K., K. Houkin) and Nuclear Medicine (K. Hirata, T.S., N.T.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan (S.K., D.K.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirata
authors.affiliation: From the Departments of Neurosurgery (S.K., D.K., K. Houkin) and Nuclear Medicine (K. Hirata, T.S., N.T.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan (S.K., D.K.).
authors.forename: Tohru
authors.initials: T
authors.lastname: Shiga
authors.affiliation: From the Departments of Neurosurgery (S.K., D.K., K. Houkin) and Nuclear Medicine (K. Hirata, T.S., N.T.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan (S.K., D.K.).
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.affiliation: From the Departments of Neurosurgery (S.K., D.K., K. Houkin) and Nuclear Medicine (K. Hirata, T.S., N.T.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan (S.K., D.K.).
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000503:physiopathology* / Q000601:surgery*; D010100:Oxygen / Q000378:metabolism*; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D013699:Temporal Arteries / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D010104:Oxygen Radioisotopes; D010100:Oxygen
keywords: brain ischemia; bypass surgery; moyamoya disease; positron emission tomography