title: Improvement of neurovascular function and cognitive impairment after STA-MCA anastomosis.
abstract: OBJECTIVE
  In patients with severe steno-occlusive disease of a main cerebral artery, decreased cerebrovascular reserve (CVR) and cognitive impairment without causative focal lesions on magnetic resonance imaging have been reported. We examined ipsilateral and contralateral CVR and cognition before and after superficial temporal artery-middle cerebral artery (MCA) anastomosis operation in patients with internal carotid artery (ICA) or MCA occlusion.
  
  
  METHODS
  In 30 patients with ICA or MCA occlusion, cognitive impairment, and decreased CVR, we examined cognition, CVR, leukoaraiosis grades, and blood data. Data from 15 patients who underwent anastomosis were compared to that in 15 patients who did not undergo anastomosis, and to bilateral data already reported on 65 patients with severe steno-occlusive disease.
  
  
  RESULTS
  Cerebral blood flow, CVR, and cognition improved after anastomosis compared to before, and compared to patients without anastomosis; improved values were maintained for 5years. CVR recovered after anastomosis, matching the linear relationship between ipsilateral and contralateral CVR seen in the 65 patients.
  
  
  CONCLUSIONS
  The postoperative improvement in cognition and synchronized recovery on the regression line between CVR of the ipsilateral occlusion and contralateral sides may suggest that the CVR is widespread and nonselectively related to cognitive function.
authors.affiliation: Department of Neurosurgery, Edogawa Hospital, Japan; Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan. Electronic address: m.ishikawa@edogawa.or.jp.
authors.forename: Mami
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Kusaka
authors.affiliation: Department of Neurosurgery, Saiseikai Central Hospital, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Terao
authors.affiliation: Department of Neurosurgery, Sano Kosei Hospital, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Nagai
authors.affiliation: Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Edogawa Hospital, Japan.
authors.forename: Heiji
authors.initials: H
authors.lastname: Naritaka
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D016014:Linear Models; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D009483:Neuropsychological Tests; D020127:Recovery of Function; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
keywords: Cerebral blood flow; Cognition; SPECT; STA-MCA anastomosis