Abstract
Moyamoya disease (MMD) patients often experience cognitive dysfunction following vascular bypass surgery, with anesthesia potentially influencing recovery. This study aims to evaluate the effects of IVA and combined intravenous and inhalational anesthesia (CIA) on cognitive recovery in MMD patients and explore influencing factors. We included 120 MMD patients who underwent vascular bypass surgery from January 1, 2021, to January 31, 2023. Patients were divided into 2 groups based on anesthesia method: intravenous anesthesia group (n = 56) and CIA group (n = 64). Cognitive function was assessed using mini-mental state examination and Montreal cognitive assessment preoperatively and at 1 week, 1 month, and 3 months postoperatively. Multivariable regression analysis was used to identify factors affecting cognitive recovery. The CIA group showed better cognitive recovery at 1 week, 1 month, and 3 months postoperatively, but the differences between groups were not statistically significant (P > .05). Multivariable regression analysis showed that anesthesia method was not an independent factor influencing recovery, while preoperative cognitive status, age, and comorbidities were significant predictors. Combined intravenous and inhalational anesthesia may offer some advantage for cognitive recovery in MMD patients after vascular bypass surgery, though the differences were not statistically significant. Preoperative cognitive status, age, and comorbidities are key factors in recovery. Anesthesia protocols should be personalized to optimize postoperative cognitive function.
Keywords: cognitive function, combined intravenous and inhalational anesthesia, intravenous anesthesia, Moyamoya disease, postoperative recovery, vascular bypass surgery
1. Introduction
Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive narrowing or occlusion of major arteries in the basal ganglia region, leading to insufficient cerebral blood flow and ischemia. MMD is classified into 2 types: hemorrhagic and ischemic, with the ischemic type being more common in clinical practice. The term “Moyamoya,” derived from a Japanese word meaning “smoke-like,” refers to the appearance seen on cerebral angiography, caused by occlusion of the middle and anterior cerebral arteries, reducing blood flow. MMD primarily affects children and young adults, especially in Asian countries, with symptoms including recurrent strokes, transient ischemic attacks, headaches, seizures, and cognitive dysfunction. Among these, cognitive dysfunction is one of the most frequent long-term sequelae.[1–6]
Treatment for MMD often involves surgical revascularization, such as bypass surgery, to restore blood flow and alleviate neurological symptoms.[7–9] These procedures help reduce stroke risk and improve quality of life. However, postoperative cognitive recovery remains a significant concern, as many studies indicate that cognitive dysfunction is particularly pronounced in the early postoperative period.[10–14] This underscores the importance of understanding how anesthesia methods may influence cognitive outcomes after surgery.
Anesthesia methods play a critical role in vascular bypass surgeries, especially for MMD patients.[15] Common approaches include intravenous anesthesia (IVA) and combined intravenous and inhalational anesthesia (CIA). Intravenous anesthesia typically uses drugs like propofol, sufentanil, and remifentanil to achieve general anesthesia.[16] While effective, IVA can lead to hemodynamic instability, particularly in patients requiring precise regulation of blood flow and cerebral circulation.
Combined intravenous and inhalational anesthesia utilizes both intravenous agents and inhalational anesthetics (e.g., sevoflurane or desflurane). This combination helps maintain anesthetic stability with minimal impact on hemodynamics, which is especially beneficial in complex surgeries.[17] For MMD patients, choosing the appropriate anesthesia method not only impacts surgical safety but also influences postoperative cognitive recovery.
Postoperative cognitive dysfunction (POCD) refers to impairments in memory, attention, executive function, and other cognitive abilities following surgery. Symptoms may include short-term memory loss, difficulty concentrating, and impaired judgment.[18] While more common in elderly patients, POCD can also affect younger individuals undergoing complex brain surgeries.[19] MMD patients are particularly susceptible to cognitive decline due to preexisting cerebrovascular insufficiency, and the anesthesia method may influence recovery.[20]
Research indicates that anesthesia methods significantly affect postoperative cognitive recovery, especially when comparing IVA and CIA.[21,22] Intravenous anesthesia may exacerbate cognitive decline, particularly when the metabolism and clearance of anesthetic drugs are altered. In contrast, CIA, with its minimal impact on hemodynamics, may reduce postoperative cognitive decline.[23] These differences are likely due to the effects of anesthesia on cerebral blood flow, neuroprotection, and recovery processes.
Moyamoya disease often manifests around age 40, and cognitive dysfunction is a common feature, particularly in the ischemic form. Postoperative cognitive recovery may be influenced by preexisting cognitive impairment. This highlights the need to explore how different anesthesia methods impact recovery. Although the effect of anesthesia on postoperative cognitive function has been studied in various surgeries, its impact on MMD patients following vascular bypass surgery remains underexplored. MMD patients face unique challenges in cognitive recovery due to preexisting brain abnormalities, making it essential to study how anesthesia methods affect recovery.
This study aims to assess the impact of IVA and CIA on early cognitive recovery after vascular bypass surgery in MMD patients. The findings will help inform clinical decisions regarding anesthesia selection to improve cognitive recovery and provide insights into the mechanisms by which anesthesia methods influence cognitive function, offering guidance for future anesthesia protocols in MMD patients.
2. Method
2.1. Study subjects
This retrospective study was approved by the Ethics Committee of Peking University International Hospital. This study included 120 patients with Moyamoya disease who underwent vascular bypass surgery at our hospital between January 1, 2021, and January 31, 2023. Among these patients, 62 were male and 58 were female, with ages ranging from 18 to 65 years and an average age of 44.2 ± 6.7 years. All patients had a confirmed diagnosis of Moyamoya disease, with typical “smoke-like” changes observed on cerebral angiography. Preoperative cognitive function assessments were conducted for all patients using the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) to exclude any other conditions or medications that could affect cognitive function.
Based on the anesthesia method used in the past, patients were divided into 2 groups: the IVA group (n = 56) and the CIA group (n = 64). The IVA group received intravenous anesthetics such as propofol and remifentanil, while the CIA group received a combination of intravenous anesthetics and inhalational anesthetics (e.g., sevoflurane or desflurane). Preoperative demographic characteristics, medical history, and relevant physiological indicators of the 2 groups were compared to ensure good comparability between the groups.
Inclusion criteria: All patients were diagnosed with Moyamoya disease and had no history of other neurological disorders (such as Alzheimer disease, Parkinson disease) or severe psychiatric disorders. Patients with cognitive impairments induced by medications (such as antipsychotic or antidepressant drugs) were also excluded.
Exclusion criteria: Patients with significant preoperative cognitive decline (MMSE < 24 or MoCA < 26) were excluded. Additionally, patients with severe cardiovascular, hepatic, or renal dysfunction, as well as those who had recently undergone neurosurgical procedures, were not included.
2.2. Sample size calculation
In this study, the sample size was calculated based on the assumption that there would be a difference in cognitive function changes (MMSE scores) between the 2 groups. The target significance level was set at 0.05, and the statistical power was set at 80%. According to data from similar past studies, the expected mean difference in cognitive score changes between the 2 groups at 1 month postoperatively was 2 points, with a standard deviation of 3 points. Using these data, sample size calculations were performed using PASS software (version 15.0), which indicated that a minimum of 56 patients per group was required. To account for possible dropouts, 10% was added to the sample size for each group, resulting in a final requirement of at least 56 patients per group.
2.3. Anesthesia protocol
Intravenous anesthesia group: Propofol and remifentanil were used for IVA maintenance. During the anesthesia maintenance phase, mechanical ventilation was employed to ensure the patient’s airway patency, and hemodynamic stability was monitored. Drug dosages were adjusted as needed based on the patient’s condition.
Combined intravenous-inhalation anesthesia group: This group used a combination of intravenous anesthetics and inhalational anesthetics (sevoflurane or desflurane). Intravenous anesthetics were used for rapid induction, while inhalational anesthetics maintained the depth of anesthesia. Drug concentrations were adjusted during the procedure according to the patient’s physiological state, with mechanical ventilation also used.
Both groups followed standard monitoring protocols during anesthesia, including electrocardiogram, blood oxygen saturation, and arterial blood pressure, to ensure anesthesia safety.
2.4. Postoperative cognitive function evaluation
Postoperative cognitive function was assessed primarily using the MMSE and the MoCA at preoperative, 1-week, 1-month, and 3-month intervals after surgery. The MMSE score was used to assess the patients’ global cognitive state, while the MoCA score focused on more detailed cognitive functions, such as executive function, language abilities, and short-term memory.
All evaluations were conducted by trained researchers, and patients were assessed in a quiet environment to minimize external distractions that could affect the results.
2.5. Data collection and statistical analysis
The basic demographic characteristics, medical history, and relevant physiological indicators of all patients were statistically analyzed. Independent sample t tests or chi-square tests were used to compare the differences between the 2 groups (P < .05 considered statistically significant). Comparisons of MMSE and MoCA scores at preoperative, 1-week, 1-month, and 3-month intervals were made to evaluate cognitive function changes, using paired t tests (P < .05).
Multivariable regression analysis was used to assess the independent effects of anesthesia methods and other factors influencing cognitive recovery (such as preoperative cognitive function, age, comorbidities, etc). Stepwise regression was employed for variable selection. Postoperative complication analysis was performed using chi-square tests (P < .05).
Cognitive function assessment at 1-year postoperative was compared using independent sample t tests or Mann–Whitney U tests (P < .05). All data analysis was conducted using SPSS statistical software (version 25.0), with results presented as mean ± standard deviation, and P < .05 was considered statistically significant.
To control for potential confounding factors, such as the depth of sedation, recovery time, and postoperative analgesia methods, a multivariable regression analysis was performed. These factors were included in the model to adjust for their influence on postoperative cognitive recovery, ensuring a more accurate evaluation of the effects of anesthesia methods.
3. Result
3.1. Comparison of baseline data of patients
This study included 120 MMD patients who underwent vascular bypass surgery between January 1, 2021, and January 31, 2023. The cohort consisted of 62 males and 58 females, aged 18 to 65 years, with a mean age of 44.2 ± 6.7 years. Patients were divided into 2 groups based on anesthesia method: the IVA group (n = 56) and the CIA group (n = 64).
Baseline demographic characteristics, medical history, and relevant physiological indicators were compared between the 2 groups, with no significant differences found. The average age was 44.1 ± 7.2 years for the IVA group and 44.3 ± 6.3 years for the CIA group (P = .82). Gender distribution was also similar: 30 males and 26 females in the IVA group, and 34 males and 30 females in the combined anesthesia group (P = .78). Additionally, there were no significant differences in smoking history, hypertension, or diabetes between the groups.
All baseline indicators were comparable between the 2 groups (P > .05), confirming that the groups were well-matched preoperatively. Although baseline cognitive impairment is common in MMD patients, all patients underwent preoperative cognitive function assessments to control for any potential impact of cognitive status on the results (Table 1).
Table 1.
Baseline data comparison.
| Baseline characteristic | Intravenous anesthesia group (n = 56) | Combined intravenous and inhalation anesthesia group (n = 64) | U/X2 value | P value |
|---|---|---|---|---|
| Age (years) | 44.1 ± 7.2 | 44.3 ± 6.3 | 0.112 | .82 |
| Gender (male/female) | 30/26 | 34/30 | 0.085 | .78 |
| Smoking history (%) | 71.4% (40/56) | 71.9% (46/64) | 1.322 | .94 |
| Hypertension history (%) | 78.6% (44/56) | 78.1% (50/64) | 1.732 | .92 |
| Diabetes history (%) | 44.6% (25/56) | 46.9% (30/64) | 0.861 | .82 |
| Systolic blood pressure (mm Hg) | 142.4 ± 11.2 | 145.2 ± 10.8 | 1.322 | .74 |
| Diastolic blood pressure (mm Hg) | 89.3 ± 7.2 | 90.6 ± 6.9 | 0.735 | .82 |
| Blood glucose (mmol/L) | 5.9 ± 1.2 | 6.0 ± 1.1 | 1.021 | .82 |
| Weight (kg) | 69.2 ± 8.1 | 70.4 ± 7.5 | 0.873 | .61 |
| Height (cm) | 168.3 ± 6.5 | 169.1 ± 5.9 | 0.271 | .72 |
| BMI (kg/m²) | 24.5 ± 3.2 | 24.8 ± 3.1 | 0.325 | .85 |
3.2. Postoperative cognitive function changes
The MMSE and MoCA were administered preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Detailed results are presented in Tables 2 and 3.
Table 2.
MMSE score changes.
| Time point | Intravenous anesthesia group (n = 56) | Combined intravenous and inhalation anesthesia group (n = 64) | T/U value (MMSE) | P value |
|---|---|---|---|---|
| Preoperative | 24.3 ± 2.1 | 24.4 ± 2.3 | U = 1072.5 | .82 |
| 1 week postoperative | 22.0 ± 3.4 (↓2.3) | 22.2 ± 3.2 (↓2.2) | U = 3.1 | >.05 |
| 1 month postoperative | 24.6 ± 3.2 (↑0.3) | 25.1 ± 3.3 (↑0.7) | U = 4.9 | >.05 |
| 3 months postoperative | 25.5 ± 3.5 (↑1.2) | 26.1 ± 3.1 (↑1.7) | U = 5.4 | >.05 |
MMSE = mini-mental state examination.
Table 3.
MoCA score changes.
| Time point | Intravenous anesthesia group (n = 56) | Combined intravenous and inhalation anesthesia group (n = 64) | T/U value (MMSE) | P value |
|---|---|---|---|---|
| Preoperative | 24.6 ± 2.5 | 24.8 ± 2.3 | U = 1074.5 | .73 |
| 1 week postoperative | 24.3 ± 3.0 (↓3.0) | 22.2 ± 2.9 (↓2.6) | U = 2.4 | >.05 |
| 1 month postoperative | 25.0 ± 3.1 (↑0.4) | 25.3 ± 3.0 (↑0.5) | U = 5.0 | >.05 |
| 3 months postoperative | 25.6 ± 3.2 (↑1.0) | 26.0 ± 2.8 (↑1.2) | U = 4.5 | >.05 |
MCA = Montreal cognitive assessment, MMSE = mini-mental state examination.
At 1 week postoperatively, both groups experienced a decrease in MMSE scores. The IVA group showed a decrease of 2.3 ± 3.4 points, while the CIA group showed a decrease of 2.2 ± 3.2 points. The difference was not statistically significant (P > .05).
At 1 month postoperatively, both groups showed some recovery, but the MMSE scores still did not return to preoperative levels. The IVA group increased by 0.3 ± 3.2 points (P > .05), and the combined anesthesia group increased by 0.7 ± 3.3 points (P > .05), with no significant difference between the groups (P > .05).
At 3 months postoperatively, MMSE scores in both groups were close to preoperative levels. The CIA group showed a decrease of 1.3 ± 3.1 points (P > .05), and the IVA group showed a decrease of 1.7 ± 3.5 points (P > .05). While the combined anesthesia group demonstrated a more pronounced recovery trend, the difference was not statistically significant (P > .05).
A similar pattern was observed in MoCA scores, with the CIA group showing greater cognitive recovery, though the difference between the groups was not statistically significant.
3.3. Analysis of factors affecting cognitive function recovery
To investigate the impact of anesthesia methods on early postoperative cognitive recovery, we conducted multivariable regression analysis. The results, shown in Fig. 1, revealed that anesthesia method (intravenous vs combined intravenous-inhalation) was not an independent factor influencing cognitive recovery (P > .05). While the combined intravenous-inhalational anesthesia group showed better cognitive recovery compared to the IVA group, this difference was not statistically significant.
Figure 1.
Forest plot of independent factors influencing early postoperative cognitive recovery.
Preoperative cognitive status (e.g., MMSE and MoCA scores) was a significant predictor of recovery (P < .01), with patients who had better preoperative cognitive function recovering more quickly. Age also influenced recovery (P < .01), with older patients exhibiting slower cognitive recovery. Additionally, comorbidities such as hypertension and diabetes significantly impacted cognitive recovery (P < .05), with patients having these conditions recovering more slowly.
3.4. Postoperative complications
In this study, the incidence of postoperative complications was compared between the IVA group and the intravenous-inhalation combined anesthesia group. The results, as shown in Table 4, indicated no significant difference in the incidence of postoperative complications between the 2 groups (P > .05). Specifically, the incidence of postoperative complications was 16.1% in the IVA group and 15.6% in the intravenous-inhalation combined anesthesia group.
Table 4.
Postoperative complications.
| Complication | Intravenous anesthesia group (n = 56) | Combined intravenous and inhalation anesthesia group (n = 64) | Chi-square (χ²) value | P value |
|---|---|---|---|---|
| Total complications | 9 (16.1%) | 10 (15.6%) | 0.02 | .88 |
| Nausea and vomiting | 3 (5.4%) | 4 (6.3%) | 0.02 | .89 |
| Hypotension | 4 (7.1%) | 3 (4.7%) | 0.13 | .72 |
| Local infection | 2 (3.6%) | 3 (4.7%) | 0.09 | .79 |
| Severe complications | 0 (0%) | 0 (0%) | – | – |
These complications were all mild in nature, including postoperative nausea and vomiting, hypotension, and local infections. The incidence of postoperative nausea and vomiting was similar between the 2 groups, with a small number of cases in both groups. Symptoms were relieved after medication. A few patients experienced postoperative hypotension, but symptoms were controlled with appropriate fluid resuscitation and medication. A small number of patients developed local infections, but these were effectively managed with routine antibiotic treatment. All patients received timely intervention, and no severe complications occurred.
4. Follow-up results
During the follow-up phase of this study (up to January 19, 2024), we assessed the cognitive recovery of patients in the CIA group and the IVA group at 1 year postoperatively. By comparing the MMSE scores at 1 year postoperatively with preoperative data, we found that cognitive function had improved in both groups, as shown in Table 5. The MMSE score of patients in the CIA group at 1 year postoperatively was 27.4 ± 2.5, which showed an improvement from the preoperative score of 24.4 ± 2.3. The difference was not statistically significant (Δ = 3.0 ± 2.2, P > .05), indicating that the cognitive function of this group had essentially returned to preoperative levels by 1 year postoperatively. In the IVA group, the MMSE score also improved, from 24.3 ± 2.1 preoperatively to 27.0 ± 3.1 at 1 year postoperatively(Δ = 2.7 ± 3.4, P > .05). Although the difference between the 2 groups was not statistically significant (P > .05), the cognitive function recovery trend in the CIA group was more pronounced.
Table 5.
Postoperative cognitive function at 1-year follow-up.
| Group | MMSE preoperative | MMSE 1 year postoperative | Change (Δ) | U value | P-value |
|---|---|---|---|---|---|
| Venous anesthesia group (n = 56) | 24.3 ± 2.1 | 27.0 ± 3.1 | 2.7 ± 3.4 | 6.5 | >.05 |
| Inhalational anesthesia group (n = 64) | 24.4 ± 2.3 | 27.4 ± 2.5 | 3.0 ± 2.2 | 1.2 | >.05 |
MMSE = mini-mental state examination.
5. Discussion
Moyamoya disease is a cerebrovascular disorder that predominantly affects middle-aged and elderly individuals, characterized by the progressive narrowing of the main arteries in the brain and impaired cerebral blood flow.[24] This disease typically leads to recurrent cerebral ischemia and strokes, often affecting the cognitive function of patients. Vascular bypass surgery is an effective treatment for Moyamoya disease, as it restores cerebral blood supply, alleviates symptoms, and improves patients’ quality of life.[25] However, POCD remains a significant clinical problem, and thus, reducing the negative impact of anesthesia on cognitive function has become a key research focus.
In this study, we investigated the effects of different anesthesia methods on postoperative cognitive recovery in Moyamoya patients following vascular bypass surgery. Baseline data analysis showed that there were no significant differences between the 2 groups in terms of preoperative demographic characteristics, medical history, and relevant physiological indicators, providing a solid foundation for subsequent analyses. The average age of the patients was around 44 years, and gender distribution was balanced, ensuring the representativeness and broad applicability of the study results. Additionally, no significant differences were found between the 2 groups regarding smoking history, hypertension, or diabetes, further minimizing the potential confounding effects of these factors on cognitive recovery.
Regarding the impact on cognitive function, anesthesia methods may have different effects on cognitive recovery in the early postoperative phase. Although the CIA group showed better cognitive recovery at 1 week, 1 month, and 3 months postoperatively compared to the IVA group, the differences between the 2 groups did not reach statistical significance (P > .05), indicating that the independent effect of anesthesia methods on postoperative cognitive recovery was limited. Nevertheless, the recovery trend was more favorable in the CIA group.
These results align with findings from previous studies. Some research supports that CIA better reduces acute postoperative cognitive decline and provides more stable recovery conditions.[26,27] However, the regression analysis in this study indicated that the anesthesia method itself was not an independent factor influencing cognitive recovery. Preoperative cognitive status, age, and comorbidities had a more significant impact on postoperative cognitive function recovery. For example, patients with better preoperative cognitive function tended to recover more quickly, while older patients had slower recovery. These findings are consistent with existing literature and highlight the importance of individual differences in cognitive recovery.[28]
Regarding postoperative complications, the incidence was similar between the 2 groups, with both groups experiencing mild symptoms (such as nausea, vomiting, hypotension, and local infections), and no severe complications were observed. This suggests that CIA did not result in a higher incidence of severe postoperative complications, supporting the safety of this anesthesia method.
In the follow-up phase (1 year postoperatively), although both groups showed improvements in MMSE scores compared to preoperative levels, the CIA group demonstrated more ideal cognitive recovery, with more significant differences. However, the differences between the 2 groups did not reach statistical significance (P > .05). These results suggest that CIA may have a positive impact on the long-term recovery of cognitive function, particularly in the early postoperative phase. Future studies may further explore the long-term effects of anesthesia methods on cognitive function recovery, especially in the context of personalized anesthesia strategies for Moyamoya patients.
This study has several limitations. First, while we adjusted for potential confounding factors through multivariable regression, the analysis did not include subgroup analyses based on cognitive status or age. Future studies could explore differences in cognitive recovery among patients with varying preoperative cognitive function, particularly to assess whether specific anesthesia methods lead to greater improvements in those with poorer cognitive function. Additionally, although the study had detailed inclusion and exclusion criteria, certain patient subgroups, such as elderly patients or those with multiple comorbidities, may have been underrepresented. These groups might exhibit different cognitive recovery patterns and could benefit from more targeted analysis. Moreover, the follow-up period was relatively short (3 months), and longer-term effects of anesthesia on cognitive recovery were not assessed. Further research should consider longer follow-up times and subgroup analyses to better understand the effects of anesthesia methods across diverse patient populations.
In conclusion, this study indicates that CIA offers certain advantages over IVA in promoting cognitive recovery following vascular bypass surgery in Moyamoya patients. Although the differences between the 2 groups did not reach statistical significance, the recovery trend in the CIA group was more favorable. Future research could further investigate the long-term effects of anesthesia methods on postoperative cognitive function, particularly through large-scale clinical trials to validate the findings of this study. Additionally, the choice of anesthesia method should consider individual patient differences and preoperative evaluations to develop the optimal anesthesia protocol for enhancing postoperative recovery.
6. Conclusion
This study suggests that CIA offers certain advantages over IVA in promoting cognitive recovery following vascular bypass surgery in Moyamoya disease patients, although the differences between the 2 groups did not reach statistical significance (P > .05). Preoperative cognitive status, age, and comorbidities significantly influence postoperative cognitive recovery. While the anesthesia method itself was not identified as an independent factor influencing cognitive recovery, CIA still demonstrated some advantage. Future studies could further explore the long-term impact of anesthesia methods on cognitive recovery, particularly through large-scale clinical trials to validate the findings of this study.
Author contributions
Conceptualization: Jing Cui, Changyu Lu, Zongsheng Xu, Lan Yao.
Data curation: Jing Cui, Changyu Lu, Zongsheng Xu, Lan Yao.
Formal analysis: Jing Cui, Changyu Lu, Lan Yao.
Funding acquisition: Jing Cui, Zongsheng Xu, Lan Yao.
Investigation: Jing Cui, Changyu Lu, Lan Yao.
Methodology: Jing Cui, Changyu Lu, Lan Yao.
Supervision: Zongsheng Xu, Lan Yao.
Validation: Zongsheng Xu, Lan Yao.
Visualization: Jing Cui, Lan Yao.
Writing – original draft: Jing Cui, Lan Yao.
Writing – review & editing: Jing Cui, Lan Yao.
Abbreviations:
- CIA
- combined intravenous and inhalational anesthesia
- IVA
- intravenous anesthesia
- MMD
- Moyamoya disease
- MMSE
- mini-mental state examination
- MoCA
- Montreal cognitive assessment
- POCD
- postoperative cognitive dysfunction
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Cui J, Lu C, Xu Z, Yao L. The impact of anesthesia methods on early postoperative cognitive function in Moyamoya disease patients after vascular bypass surgery. Medicine 2025;104:35(e43317).
Contributor Information
Jing Cui, Email: cuijing@pkuih.edu.cn.
Changyu Lu, Email: luchangyu@pkuih.edu.cn.
Zongsheng Xu, Email: xuzongsheng@pkuih.edu.cn.
References
- [1].Ihara M, Yamamoto Y, Hattori Y, et al. Moyamoya disease: diagnosis and interventions. Lancet Neurol. 2022;21:747–58. [DOI] [PubMed] [Google Scholar]
- [2].Gonzalez NR, Amin-Hanjani S, Bang OY, et al. Adult Moyamoya disease and syndrome: current perspectives and future directions: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2023;54:e465–79. [DOI] [PubMed] [Google Scholar]
- [3].Zhang G, Liu E, Tan X, Liu C, Yang S. Research progress on Moyamoya disease combined with thyroid diseases. Front Endocrinol (Lausanne). 2023;14:1233567. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].He S, Wang Y, Liu Z, et al. Metabolomic signatures associated with pathological angiogenesis in Moyamoya disease. Clin Transl Med. 2023;13:e1492. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Chiang CC, Shahid AH, Harriott AM, et al. Evaluation and treatment of headache associated with Moyamoya disease: a narrative review. Cephalalgia. 2022;42:542–52. [DOI] [PubMed] [Google Scholar]
- [6].Singh R, Bauman MMJ, Seas A, et al. Association of Moyamoya vasculopathy with autoimmune disease: a systematic review and pooled analysis. Neurosurg Rev. 2023;46:220. [DOI] [PubMed] [Google Scholar]
- [7].Zhang X, Xiao W, Zhang Q, et al. Progression in Moyamoya disease: clinical features, neuroimaging evaluation, and treatment. Curr Neuropharmacol. 2022;20:292–308. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Zhang L, Xu K, Zhang Y, Wang X, Yu J. Treatment strategies for aneurysms associated with Moyamoya disease. Int J Med Sci. 2015;12:234–42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Shang S, Zhou D, Ya J, et al. Progress in Moyamoya disease. Neurosurg Rev. 2020;43:371–82. [DOI] [PubMed] [Google Scholar]
- [10].Twine CP, McLain AD. Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev. 2010:CD001487. [DOI] [PubMed] [Google Scholar]
- [11].Chen Y, Wu W, Zhang X, Fan W, Shen L. Feasibility study on retinal vascular bypass surgery in isolated arterially perfused caprine eye model. Eye (Lond). 2011;25:1499–503. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12].Duranti L, Tavecchio L. Major vascular reconstructions in thoracic oncological surgery. Updates Surg. 2024;76:1887–98. [DOI] [PubMed] [Google Scholar]
- [13].Zeng K, Long J, Li Y, Hu J. Preventing postoperative cognitive dysfunction using anesthetic drugs in elderly patients undergoing noncardiac surgery: a systematic review and meta-analysis. Int J Surg. 2023;109:21–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Bhushan S, Li Y, Huang X, Cheng H, Gao K, Xiao Z. Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: a review article. Int J Surg. 2021;95:106163. [DOI] [PubMed] [Google Scholar]
- [15].Vutskits L, Xie Z. Lasting impact of general anaesthesia on the brain: mechanisms and relevance. Nat Rev Neurosci. 2016;17:705–17. [DOI] [PubMed] [Google Scholar]
- [16].Liu X, Ji J, Zhao GQ. General anesthesia affecting on developing brain: evidence from animal to clinical research. J Anesth. 2020;34:765–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev. 2018;8:CD012317. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].He L, Duan X, Li S, Zhang R, Dai X, Lu M. Unveiling the role of astrocytes in postoperative cognitive dysfunction. Ageing Res Rev. 2024;95:102223. [DOI] [PubMed] [Google Scholar]
- [19].Zhou Y, Ju H, Hu Y, et al. Tregs dysfunction aggravates postoperative cognitive impairment in aged mice. J Neuroinflammation. 2023;20:75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [20].Sun L, Yong Y, Wei P, et al. Electroacupuncture ameliorates postoperative cognitive dysfunction and associated neuroinflammation via NLRP3 signal inhibition in aged mice. CNS Neurosci Ther. 2022;28:390–400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Maranhao B, Liu M, Palanisamy A, Monks DT, Singh PM. The association between post-dural puncture headache and needle type during spinal anaesthesia: a systematic review and network meta-analysis. Anaesthesia. 2021;76:1098–110. [DOI] [PubMed] [Google Scholar]
- [22].Oner S, Onen E, Caglayan V, et al. The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males. Ann Med. 2023;55:2238185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [23].Kong E, Nicolaou N, Vizcaychipi MP. Hemodynamic stability of closed-loop anesthesia systems: a systematic review. Minerva Anestesiol. 2020;86:76–87. [DOI] [PubMed] [Google Scholar]
- [24].Kuroda S, Fujimura M, Takahashi J, et al. Diagnostic criteria for moyamoya disease – 2021 revised version. Neurol Med Chir (Tokyo). 2022;62:307–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [25].Krafcik BM, Sachs TE, Farber A, et al. Assessment of open operative vascular surgical experience among general surgery residents. J Vasc Surg. 2016;63:1110–5. [DOI] [PubMed] [Google Scholar]
- [26].Kostopanagiotou G, Markantonis SL, Polydorou M, Pandazi A, Kottis G. Recovery and cognitive function after fentanyl or remifentanil administration for carotid endarterectomy. J Clin Anesth. 2005;17:16–20. [DOI] [PubMed] [Google Scholar]
- [27].Cai S, Tang AC, Luo TY, et al. Effect of basal forebrain somatostatin and parvalbumin neurons in propofol and isoflurane anesthesia. CNS Neurosci Ther. 2021;27:792–804. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [28].Howell K, Garvan C, Amini S, et al. Association between preoperative anemia and cognitive function in a large cohort study of older patients undergoing elective surgery. Anesth Analg. 2025;140:14–23. [DOI] [PMC free article] [PubMed] [Google Scholar]