Impact of revascularization strategy on postoperative cognitive function and return-to-work in adults with ischemic moyamoya disease.

Introduction: The present prospective observational study aimed to clarify the impacts of different types of revascularization surgery on the inability to achieve postoperative return-to-work (RTW) among working-age adults (age range, 30-60 years) with ischemic-onset moyamoya disease (MMD) and misery perfusion.

Methods: Of 52 patients who were employed full-time at the onset of ischemic symptoms, 29 underwent direct revascularization in the first study period and 23 underwent indirect revascularization alone in the second study period. Whether each patient achieved a return to their original employment within 6 months after surgery was determined.

Results: Forty patients (77%) achieved RTW within 6 months after revascularization surgery, but 12 patients (23%) did not. Logistic regression analysis of variables related to the inability to achieve postoperative RTW using the sequential backward elimination approach showed that direct revascularization (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.35 - 2.53;  = 0.0441), postoperative cerebral hyperperfusion syndrome (OR, 5.65; 95% CI, 3.57 - 27.8;  = 0.0096), or declined cognition at 1-2 months postoperatively (OR, 38.5; 95% CI, 5.35 - 250.00;  = 0.0003) were independent predictors of an inability to achieve postoperative RTW.

Discussion: Declined cognition at 1-2 months postoperatively due to adverse phenomena including cerebral hyperperfusion syndrome after direct revascularization may be associated with an inability to achieve postoperative RTW among working-age adult patients with ischemic-onset MMD and misery perfusion. Indirect revascularization alone may thus be preferable to direct revascularization for such patients.