ArticleCNS neuroscience & therapeutics2026
Unusual Synchronous Arbitrary-Gate Doppler Spectra Enable Intraoperative Hemodynamic Warning of Cerebral Hyperperfusion Syndrome on Moyamoya Disease.
Article in CNS neuroscience & therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCerebral hyperperfusion syndrome (CHS) is a serious complication following revascularization in moyamoya disease (MMD) patients, yet reliable predictors remain scarce. This study aims to evaluate subcortical hemodynamics intraoperatively using a novel ultrasound imaging technique, synchronous arbitrary gate spectral Doppler (SAGSD), and to identify indicators associated with CHS.
methodsA total of thirty adult MMD patients undergoing revascularization were included. Intraoperative SAGSD imaging, conventional Doppler ultrasound, and indocyanine green videoangiography (ICG-VA) were performed to assess subcortical hemodynamics at multiple sites before and after anastomosis.
resultsAll thirty patients underwent revascularization, and five of the six CHS patients exhibited a distinctive "mountain" sign on SAGSD, characterized by three or more discrete velocity peaks within a single cardiac cycle observed simultaneously across two or more sampling sites. The CHS patients showed a significant increase in velocity-time integral (VTI) change (median Δ + 0.48 cm [95% CI, 0.31 to 0.65], p < 0.001) post-anastomosis on SAGSD, while conventional Doppler showed no significant change in flow velocity (all p > 0.05). Notably, in CHS patients, ICG-VA showed no statistical difference in flow velocity, delay, and time to peak after anastomosis (all p > 0.05), whereas SAGSD demonstrated hemodynamic changes such as VTI (median Δ + 0.67 cm [95% CI, 0.43-0.90], p < 0.001) via Doppler spectrum.
conclusionSAGSD enables highly sensitive, multi-position, and contrast-free hemodynamic evaluation of deep cerebral microvasculature. The "mountain" sign, a novel spectral morphology corroborated by quantitative VTI elevation, is a specific intraoperative biomarker strongly associated with CHS, offering a potential predictor for early intervention and improved surgical outcomes.
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