Decreased frontal white-matter diffusion and improved cognitive flexibility after burr-hole surgery in moyamoya angiopathy

Lionel Calviere,Paul Loubiere,Melanie Planton,Jean Christophe Sol,Helene Mirabel,Vanessa Cazzola,Isabelle Catalaa,Fabrice Bonneville,Fabrice Bonneville,Fabrice Bonneville

doi:10.1186/s12883-020-1614-x

Lionel Calviere, Paul Loubiere + Show 8 more

Open Access

https://doi.org/10.1186/s12883-020-1614-x

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Abstract

BackgroundIn Moyamoya Angioplasty (MMA), increased apparent diffusion coefficient (ADC) in frontal white matter (WM) with a normal appearance has been associated with frontal hypoperfusion and executive dysfunction. Multiple burr-hole surgery enables the revascularization of large frontal areas.Goal: To assess the effect of multiple burr-hole surgery on the ADC and cognitive functions in adults with MMA.MethodsADC was measured in 26 brain hemispheres of 14 consecutive adults with MMA (9 women, mean age ± SD: 38.1 ± 10.7 years) prior to and 6 months after burr-hole surgery. ADC was obtained from regions of interest located in frontal and posterior (temporo-occipital) normal-appearing WM. Ten patients had neuropsychological assessment that focused on executive and attentional functions before and after surgery.ResultsAnterior and posterior ADC values did not differ before surgery (815.8 ± 60.1 vs. 812.1 ± 35.3 mm2/s, p = 0.88). After surgery, frontal ADC was lower than prior to surgery (789.9 ± 64.5 vs. 815.8 ± 60.1 mm2/s; p <0.001) whereas no change occurred in posterior ADC (p = 0.31). Trail-making test part B median z-score increased from − 1.47 to − 0.21 (p = 0.018), suggesting improved cognitive flexibility.ConclusionIn adults with MMA, indirect revascularization with burr-hole is followed by a decrease of ADC in normal-appearing frontal WM and may have improved some executive functions in the flexibility process. Change in ADC may reflect the improvement in cerebral perfusion after surgery. The measuring of ADC may be a promising tool in exploring potentially reversible microstructural WM damage related to hypoperfusion and cognitive change in MMA.

Highlights

Moyamoya Angioplasty (MMA) is characterised by progressive stenosis and occlusion of the intracranial carotid artery and its main branches, with the development of a basal collateral network [1]
We have previously demonstrated an association between executive dysfunction, reduced frontal cerebrovascular reserve (CVR) and increased apparent diffusion coefficient (ADC) in normal-appearing frontal white matter (WM) [11, 12]
Burr-hole surgery in adult patients with MMA and frontal hypoperfusion is followed by a decrease in ADC values that tended to normalize; in frontal normalappearing WM

Summary

Introduction

Moyamoya Angioplasty (MMA) is characterised by progressive stenosis and occlusion of the intracranial carotid artery and its main branches, with the development of a basal collateral network [1] These occlusive arterial lesions lead to chronic impairment of cerebral perfusion, often in frontal areas, resulting in stroke and cognitive disorders [2, 3]. We have previously demonstrated an association between executive dysfunction, reduced frontal CVR and increased ADC in normal-appearing frontal WM [11, 12]. In Moyamoya Angioplasty (MMA), increased apparent diffusion coefficient (ADC) in frontal white matter (WM) with a normal appearance has been associated with frontal hypoperfusion and executive dysfunction.

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