An alternative ultrasonographic approach to assess basilar artery flow

Assessment of basilar artery blood flow is of interest in many neurosurgical situations. With use of ultrasonography, the standard posterior approach is difficult in neurointensive care.

To evaluate the accuracy of an alternative submandibular approach for the assessment of blood flow in the basilar artery.

Fifty adult trauma patients without cervical spine injury were included in a prospective, comparative study. Doppler color-coded sonography of the basilar artery was performed using a 2-MHz pulsed probe. Blood flow velocities and pulsatility indexes obtained from the new submandibular approach and the standard suboccipital approach were compared.

There were no significant differences in systolic, mean, and end-diastolic velocities between both approaches. Strong relationships were found between suboccipital and submandibular approaches for systolic, mean, end-diastolic velocities, and pulsatility indexes (r = 0.94, 0.95, 0.95, and 0.91, respectively; P < .001 for all). The mean bias between suboccipital and submandibular approaches was 1.1 cm/s for systolic velocity, 0.4 cm/s for mean velocity, -1.2 cm/s for end-diastolic velocity, and 0.0 for pulsatility index.

This alternative submandibular approach appears to be accurate in measuring blood flow velocity and pulsatility index in the basilar artery. The main advantage of this approach is to facilitate monitoring of brainstem perfusion by avoiding neck flexion. This can be very helpful in intensive care settings.