{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:35:32Z","timestamp":1787319332353,"version":"build-2736575974"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Moyamoya disease (MMD) is a cerebrovascular condition characterized by progressive stenosis of the main branches of the cerebral artery. Patients with MMD are prone to cognitive decline due to chronic hypoperfusion. Whether revascularization surgery can reverse cognitive dysfunction by improving cerebral blood flow perfusion and what types and levels of cognitive dysfunction can benefit most from the surgery remain unclear.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Between July 31, 2022, and May 15, 2024, a total of 155 patients were prospectively enrolled in this trial and underwent combined or indirect revascularization with an average 6-month follow-up. Eleven types of cognitive domains were tested. Subgroup analysis was used to compare the postoperative benefits of different surgical procedures and preoperative cognitive levels.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Choice reaction time (adjusted p = 0.032), verbal working memory (adjusted p = 0.006), mental rotation (adjusted p = 0.002), complex subtraction (adjusted p < 0.001), and word memory (adjusted p < 0.001) improved significantly after surgery. Combined revascularization led to improvement in more cognitive domains (choice reaction time, p < 0.001; mental rotation, p < 0.001; word memory, p < 0.001; executive inhibition in the same direction, p = 0.016; complex subtraction, p = 0.001; and verbal working memory in reverse order, p = 0.001) than indirect revascularization (word memory, p = 0.023; and complex subtraction, p = 0.007).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Revascularization can selectively reverse cognitive dysfunction by improving cerebral blood flow perfusion in adults with MMD. Combined revascularization may allow more definite hemodynamic improvement than indirect revascularization, leading to more frequent and greater potential improvement in more cognitive domains; however, more studies are needed to confirm this. A population with lower preoperative cognition and good postoperative collateral formation may benefit more from the surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.11.jns241932","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T06:15:30Z","timestamp":1743228930000},"page":"521-529","source":"Crossref","is-referenced-by-count":1,"title":["Improvement in multiple cognitive domains via combined revascularization by 6 months\u2019 follow-up: a new potential surgical indication in moyamoya disease"],"prefix":"10.3171","volume":"143","author":[{"given":"Ziqi","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaokuan","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoran","family":"Shen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihao","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junze","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanru","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xilong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peking University International Hospital, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weitao","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peking University International Hospital, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chinese PLA General Hospital, Beijing; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinlin","family":"Zhou","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongbo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Ann Rehabil Med","first-page":"1","article-title":"Neurocognitive dysfunction according to hypoperfusion territory in patients with Moyamoya disease","volume":"41","author":"Kang CG","year":"2017","unstructured":"Kang CG, Chun MH, Kang JA, Do KH, Choi SJ. Neurocognitive dysfunction according to hypoperfusion territory in patients with Moyamoya disease. Ann Rehabil Med. 2017;41(1):1\u20138."},{"issue":"4","key":"b2","series-title":"J Cereb Blood Flow Metab","first-page":"542","article-title":"Association of cognitive function and hypoperfusion in Moyamoya disease patients without stroke","volume":"43","author":"Shen XX","year":"2023","unstructured":"Shen XX, Zhang HD, Fu HG, Association of cognitive function and hypoperfusion in Moyamoya disease patients without stroke. J Cereb Blood Flow Metab. 2023;43(4):542\u2013551."},{"issue":"3","key":"b3","series-title":"Neurosurgery","first-page":"634","article-title":"Neurocognitive impairment in adults with moyamoya disease without stroke","volume":"70","author":"Karzmark P","year":"2012","unstructured":"Karzmark P, Zeifert PD, Bell-Stephens TE, Steinberg GK, Dorfman LJ. Neurocognitive impairment in adults with moyamoya disease without stroke. 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BMC Neurol. 2020;20(1):322."},{"issue":"4","key":"b12","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"2021 Japanese Guidelines for the Management of Moyamoya Disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society","volume":"62","author":"Fujimura M","year":"2022","unstructured":"Fujimura M, Tominaga T, Kuroda S, 2021 Japanese Guidelines for the Management of Moyamoya Disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir (Tokyo). 2022;62(4):165\u2013170."},{"issue":"4","key":"b13","series-title":"Cogn Process","first-page":"521","article-title":"Visual form perception predicts 3-year longitudinal development of mathematical achievement","volume":"21","author":"Zhou X","year":"2020","unstructured":"Zhou X, Hu Y, Yuan L, Gu T, Li D. Visual form perception predicts 3-year longitudinal development of mathematical achievement. 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BMC Neurol. 2020;20(1):322."},{"issue":"4","key":"b12","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"2021 Japanese Guidelines for the Management of Moyamoya Disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society","volume":"62","author":"Fujimura M","year":"2022","unstructured":"Fujimura M, Tominaga T, Kuroda S, 2021 Japanese Guidelines for the Management of Moyamoya Disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir (Tokyo). 2022;62(4):165\u2013170."},{"issue":"4","key":"b13","series-title":"Cogn Process","first-page":"521","article-title":"Visual form perception predicts 3-year longitudinal development of mathematical achievement","volume":"21","author":"Zhou X","year":"2020","unstructured":"Zhou X, Hu Y, Yuan L, Gu T, Li D. Visual form perception predicts 3-year longitudinal development of mathematical achievement. 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