# Impact of Anesthesia on Brain Functional Networks in Moyamoya Disease and Spinal Lesions

## TL;DR

This study examines how anesthesia affects brain networks in patients with moyamoya disease and spinal lesions using MRI.

## Contribution

The study reveals disease-specific and drug-induced changes in brain connectivity under anesthesia in moyamoya patients.

## Key findings

- Patients with moyamoya disease showed reduced nodal strength and efficiency in key brain networks when awake.
- Anesthesia caused further decreases in brain network connectivity in moyamoya patients.
- DMN connectivity correlated with cognitive scores, suggesting cognitive impact from altered brain networks.

## Abstract

To analyze the effects of intravenous propofol combined with remifentanil on whole‐brain functional networks in patients with ischemic moyamoya disease (IMMD) and intraspinal space‐occupying lesions (SOLs) using resting‐state functional magnetic resonance imaging (rs‐fMRI).

Ten patients with IMMD and 10 sex‐ and age‐matched patients with lumbar SOL (normal cerebrovascular findings on preoperative MRI) were recruited. General anesthesia was administered using propofol and remifentanil. rs‐fMRI imaging was performed in both awake and anesthetized states. Whole‐brain functional network in different states was constructed based on graph theory tools.

In awake patients with IMMD, significant reductions in nodal strength (NS) were observed in the default mode network (DMN), sensorimotor network, and frontoparietal control network (FPN), compared to patients with SOL. Nodal efficiency (NE) showed further significant network declines. Under anesthesia, patients with IMMD: (1) exhibited disease‐specific decreases in NS and NE across several networks, potentially reflecting underlying cerebral pathology. (2) Propofol's effects also contributed to significant NS and NE reductions in several brain regions. Changes before and after anesthesia in patients with IMMD were significantly decreased in specific regions (discussed in detail) per analysis of NS versus NE. DMN connectivity correlated moderately with Montreal Cognitive Assessment scores.

Reduced whole‐brain functional connectivity in patients with IMMD before anesthesia was similar to the alterations caused by systemic intravenous drugs administered after anesthesia.

ChiCTR2300075268

Ischemic MMD alters brain network connectivity, impacting cognition and executive function. Patients with ischemic MMD under propofol combined with remifentanil anesthesia showed decreases in the DMN, SEN, FPN, and SAN. Anesthetic protocols should consider MMD‐related brain changes to minimize cognitive impact.