Color Doppler Ultrasound Enhances Moyamoya Surgery Outcomes in Children

Color Doppler ultrasound is a valuable tool in assessing hemodynamic changes in children with moyamoya disease undergoing combined revascularization surgery. Moyamoya disease is a chronic stenotic and occlusive vasculopathy affecting intracranial vessels, leading to compensatory changes in cerebral blood supply. While traditional imaging methods like computed tomography and angiography are invasive, color Doppler ultrasound offers a noninvasive and rapid alternative for pediatric patients.

Historically, Moyamoya disease primarily affects the internal carotid artery and the middle and anterior cerebral arteries, necessitating compensatory blood supply from the external carotid and vertebrobasilar artery systems. The formation of neovascularizations at the skull base, resembling “smoke,” contributes to the disease’s name. Collateral branches from the external carotid and vertebral arteries progressively dilate to offset ischemic effects, highlighting the importance of monitoring blood flow dynamics in affected children.

Color Doppler ultrasound allows for the assessment of arterial parameters like diameter, peak systolic velocity, resistance index, and blood flow volume in children with Moyamoya disease. This study conducted preoperative and postoperative evaluations at different time points to track hemodynamic alterations in the carotid and superficial temporal arteries. The findings indicated improved blood flow from the external carotid system to intracranial circulation following revascularization surgery, with significant changes in arterial parameters postoperatively.

The study revealed that the superficial temporal artery underwent significant modifications post-surgery, transitioning from a medium-resistance artery to a low-resistance artery supplying intracranial circulation. The diameter, peak systolic velocity, and blood flow volume of the superficial temporal artery increased postoperatively, indicating successful direct revascularization. These findings align with outcomes observed in other studies on Moyamoya patients undergoing revascularization procedures.

Additionally, the study observed gradual increases in blood flow parameters of the external carotid artery on the operative side, suggesting the initiation of indirect revascularization effects. Monitoring these changes through color Doppler ultrasound may aid clinicians in predicting postoperative outcomes and ensuring appropriate blood pressure control to prevent complications like ischemic strokes or hyperperfusion.

In conclusion, color Doppler ultrasound serves as a valuable adjunct to traditional imaging techniques for evaluating hemodynamic changes in children with Moyamoya disease undergoing combined revascularization surgery. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings and establish the role of color Doppler ultrasound in standard care practices for pediatric Moyamoya patients.