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The value of transcranial Doppler ultrasonography in craniosynostosis
P V Govender1, S S Nadvi, A Madaree
1Durban Craniofacial Unit, University of Natal Medical School, Durban, South Africa.
Insights
Transcranial Doppler ultrasonography (TCD) offers a safe, noninvasive method to assess intracranial pressure (ICP) in children with craniosynostosis. A decrease in the pulsatility index (PI) post-surgery indicates a positive outcome, while a rise suggests complications.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Neurology
Background:
- Craniosynostosis can lead to elevated intracranial pressure (ICP) in children, necessitating surgical intervention.
- Current ICP measurement methods are invasive, costly, and require specialized skills.
- Transcranial Doppler ultrasonography (TCD) presents a noninvasive, safe, and cost-effective alternative for ICP assessment.
Purpose of the Study:
- To prospectively evaluate the utility of TCD in assessing ICP in pediatric craniosynostosis patients.
- To correlate TCD findings with direct ICP measurements and computed tomography (CT) scans.
- To determine the clinical significance of TCD pulsatility index (PI) changes before and after surgical decompression.
Main Methods:
- Prospective evaluation of 16 children with craniosynostosis.
- Transcranial Doppler (TCD) ultrasonography performed pre- and post-surgery to measure pulsatility index (PI).
- Correlation of TCD findings with intraoperative lumbar puncture (LP) ICP measurements and CT scan results.
Main Results:
- Poor correlation was observed between TCD, direct ICP measurements, and CT findings.
- A significant fall in TCD-derived PI post-surgery was clinically useful.
- An increase in PI after surgery was identified as an ominous indicator.
Conclusions:
- While direct correlation with other modalities was limited, TCD is a valuable tool for monitoring ICP trends in craniosynostosis.
- Post-operative changes in TCD pulsatility index (PI) provide clinically relevant information regarding patient outcomes.
- TCD offers a safe and accessible method for assessing the effectiveness of surgical decompression in pediatric craniosynostosis.
Abstract:
Some children with craniosynostosis demonstrate raised intracranial pressure (ICP), requiring surgical decompression. Conventional methods of measuring ICP in such children are invasive, expensive, and require expertise. Transcranial Doppler ultrasonography (TCD) is an alternative, useful means of assessing ICP qualitatively, and is noninvasive, inexpensive, and safe. We evaluated the use of TCD prospectively in 16 children with craniosynostosis and correlated TCD findings with intraoperative ICP measurements by lumbar puncture (LP) and with computed tomographic (CT) findings. TCD evaluations were performed before and after surgery to determine the pulsatility index (PI), which is known to show close correlation with ICP. The three modalities--TCD, ICP, and CT--showed poor correlation with each other. However, the fall in the PI value after surgery, as determined by TCD, was shown to be clinically useful, with a rise in the PI value after surgery being an ominous sign.