Abstract
OBJECTIVE: Postoperative motor aphasia is a common complication following left-sided combined revascularization surgery for Moyamoya disease (MMD), yet reliable preoperative predictors remain unavailable. This study evaluates preoperative temporal muscle thickness (TMT), a novel MRI-based parameter, as a predictive biomarker for this complication. METHODS: We retrospectively analyzed 34 adult MMD patients who underwent left-sided combined revascularization between April 2021 and June 2023. Preoperative TMT was measured on axial MRI using multi-planar reformation. Statistical analyses (e.g., t-tests) were used to assess the association between preoperative TMT and the incidence, timing, and duration of postoperative motor aphasia. RESULTS: Excluding complications such as infarction, postoperative aphasia occurred in 28 of 34 patients (82.35%), predominantly pure motor aphasia (25/34, 73.53%), typically emerging on the third postoperative day with a median duration of 4 days. Patients who developed aphasia had significantly greater mean preoperative TMT than those who did not (7.08 ± 1.00 mm vs. 5.70 ± 0.68 mm, respectively; p = 0.003). Furthermore, greater preoperative TMT showed a positive correlation with a longer duration of postoperative aphasia (r = 0.4907, p = 0.0032). CONCLUSION: Our findings confirm that TMT independently predicts the occurrence and severity of postoperative motor aphasia in MMD patients after left-sided revascularization. This MRI metric enhances risk stratification, guiding surgical planning and patient counseling. Further studies are needed to validate its utility and explore preventive measures.