Ultrasonography for Serial Monitoring and Management of Cerebrospinal Fluid Dynamic Disorders After Decompressive...

Area of Science:

• Neurosurgery
• Neurocritical Care
• Diagnostic Imaging

Background:

• Decompressive craniectomy (DC) is crucial for treating severe head injury-induced intracranial hypertension.
• Post-DC complications include cerebrospinal fluid (CSF) hydrodynamics impairments like hydrocephalus and subdural effusions.
• Continuous intracranial pressure monitoring is standard in neurocritical care following DC.

Purpose of the Study:

• To evaluate the utility of transcranial duplex sonography (TDS) for serial monitoring and management of CSF disorders after DC.
• To assess TDS's role in detecting and managing complications such as hydrocephalus and intracranial effusions.

Main Methods:

• 100 patients undergoing DC were studied between June 2016 and May 2019.
• Transcranial duplex sonography (TDS) examinations were conducted 1 day to 1 year post-DC.
• TDS monitored ventricle size/morphology, intraventricular hemorrhage, hydrocephalus, hygromas, and CSF release procedures.

Main Results:

• 456 TDS examinations were performed; 402 in the neuro-intensive care unit.
• TDS guided external ventricular drainage in two patients with intraventricular hemorrhage.
• TDS diagnosed 29 cases of hydrocephalus, consistent with CT findings, and identified 18 intracranial effusions.

Conclusions:

• Transcranial duplex sonography (TDS) efficiently monitors ventricle changes and intracranial effusions post-DC.
• Its noninvasive, bedside, real-time, and inexpensive nature makes TDS a valuable tool.
• TDS can potentially replace cranial computed tomography for daily patient inspection after DC.