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Updated: Feb 10, 2026
Assessment of Cerebral Lateralization in Children using Functional Transcranial Doppler Ultrasound fTCD
Published on: September 27, 2010
[Methods to assess competence of indirect cerebral revascularization in children]
V A Khachatryan1, K A Samochernykh1, M R Mamatkhanov1
1Almazov National Medical Research Center, Akkuratova Str., 2, Saint-Petersburg, Russia, 197341.
Insights
Catheterization cerebral angiography (CCA) is traumatic for pediatric indirect cerebral revascularization (ICR) assessment. Magnetic resonance angiography (MRA) and triplex ultrasound (TU) are optimal for evaluating ICR competence post-surgery.
Area of Science:
- Pediatric neurosurgery
- Vascular imaging
- Cerebral blood flow assessment
Background:
- Catheterization cerebral angiography (CCA) for indirect cerebral revascularization (ICR) assessment in children is invasive, involves high radiation, and often requires anesthesia.
- There is a need for less invasive and safer methods to evaluate the success of ICR.
Purpose of the Study:
- To compare the effectiveness of triplex ultrasound (TU), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and CCA in assessing indirect cerebral revascularization (ICR) competence in pediatric patients.
- To identify the most suitable imaging modalities for postoperative evaluation of ICR.
Main Methods:
- Eighteen children underwent ICR surgery (24 hemispheres).
- Pre- and postoperative assessments included clinical examinations, TU of the superficial temporal artery, MRI/CT angiography, and selective cerebral angiography.
- Evaluation used the Matsushima classification.
Main Results:
- Postoperative improvements in neurological and neuropsychological status were observed.
- Matsushima grade A collaterals were found in 50% of cases.
- MR angiography visualized 75% of indirect anastomoses, while CTA and TU visualized 25% each.
- TU showed significant changes in superficial temporal artery blood flow post-surgery, including increased flow rate and decreased resistance.
Conclusions:
- CCA is indicated for ICR competence assessment when clinical signs of cerebral insufficiency persist, superficial temporal artery blood flow is suboptimal, or MRA shows no anastomosis.
- MRA with perfusion/diffusion mapping and TU are the most optimal techniques for postoperative ICR evaluation.
Abstract:
The use of catheterization cerebral angiography (CCA) to assess collateral blood flow through an indirect anastomosis is traumatic for children, uses a high radiation dose, and requires anesthetic care in most cases.
Aim:
we aimed to compare the capabilities of triplex ultrasound (TU) of vessels, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and CCA in assessing the competence of indirect cerebral revascularization (ICR) in children.
Material And Methods:
ICR was performed in 18 children in 24 hemispheres (24 operations). The results were evaluated by Matsushima classification-based comparison of the data of preoperative and postoperative clinical examinations, TU of the superficial temporal artery, magnetic resonance imaging (MRI) and computed tomography (CT) of vessels, and selective cerebral angiography.
Results:
After surgery, improvements in the neurological and neuropsychological status were assessed. Matsushima grade A collaterals were found in 12 (50%) cases, grade B collaterals were present in 3 (13%) cases, grade C collaterals were present in 7 (29%) cases, and grade D collaterals were detected in 1 (4%) case; in 1 (4%) case, the superficial temporal artery was not enhanced. MR angiography visualized 18 (75%) indirect anastomoses, CT angiography revealed 4 indirect anastomoses, and TU visualized 4 indirect anastomoses. Comparison of preoperative and postoperative TU data for the superficial temporal artery revealed significant changes in blood flow in the form of increased rate indices and a decreased resistance index; mean values of indices for each angiographic class of revascularization and significant differences in pre- and postoperative observations were calculated.
Conclusion:
Examination of ICR competence using CCA is necessary in the presence of persistent clinical signs of chronic cerebral circulatory insufficiency, absence of increased blood flow and decreased peripheral resistance in the superficial temporal artery, and lack of anastomosis according to MRA. The most optimal techniques for postoperative examination are MRA with perfusion and diffusion maps and TU.
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