Transcranial ultrasonography via sonolucent implants: a review

Transcranial ultrasound (TCUS) imaging techniques via sonolucent implants have demonstrated clinical utility across a variety of settings and are increasingly being adopted in neurosurgical and neurocritical care practices worldwide. This review appraises the use of ultrasound through sonolucent implants in clinical contexts, providing a critical evaluation of its diagnostic, prognostic, and therapeutic potential. We discuss its application in selected areas such as ventricular size assessment and hydrocephalus monitoring, postoperative surveillance for fluid collections and hemorrhage, bypass patency assessment in cerebrovascular surgery, and functional brain imaging. Emerging interventional use of this technique as a platform for focused ultrasound therapies is also explored. Future directions for research and clinical integration are discussed. Technical challenges and inherent limitations of ultrasound data acquired through sonolucent implants - including device-specific considerations, imaging artifacts, and the absence of standardized protocols - are critically addressed, alongside a forward-looking discussion of research priorities and barriers to clinical adoption.