Ultrasonographic Changes after Indirect Revascularization Surgery in Pediatric Patients with Moyamoya Disease

Abstract

The marked cerebral hypoperfusion of moyamoya disease (MMD) can be treated with encephaloduroarteriosynangiosis (EDAS), an indirect revascularization surgery. Collateral establishment after the surgery is a gradual process; thus, easy access to serial assessment is of great importance. We prospectively recruited 15 pediatric moyamoya patients who underwent EDAS surgeries on a total of 19 hemispheres. Ultrasonography of extracranial and intracranial arteries was performed pre-operatively and post-operatively at 1, 3 and 6 mo. Among the extracranial arteries, the superficial temporal artery had the most pronounced increase in flow velocity and decrease in flow resistance from 1 mo post-surgery (p < 0.01). Among the large intracranial arteries, a significant increase in peak systolic velocity was observed in the anterior cerebral artery from 3 mo post-surgery (p < 0.05). These findings indicate significant hemodynamic changes on ultrasonography in pediatric moyamoya patients after indirect revascularization surgery.

Keywords: Encephaloduroarteriosynangiosis; Indirect revascularization; Moyamoya disease; Pediatric stroke; Ultrasonography.