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Updated: Aug 5, 2026
Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow
Published on: March 15, 2021
Transcranial Ultrasound Monitoring of Chronic Subdural Hematoma
Riccardo Serra1, Jordan R Saadon1, Maureen L Rakovec1
1Department of Neurosurgery, University of Maryland, Baltimore, Maryland, United States.
Insights
Point-of-care ultrasound (US) with sonolucent burr-hole covers offers a viable alternative to CT scans for monitoring chronic subdural hematoma (cSDH) recurrence post-surgery. This novel technique shows high concordance with CT, aiding in efficient patient follow-up.
Area of Science:
- Neurosurgery
- Medical Imaging
- Ultrasound Technology
Background:
- Chronic subdural hematoma (cSDH) is a growing neurosurgical concern, projected to be the most common pathology by 2030.
- Postoperative monitoring is crucial due to high recurrence rates and challenges with anticoagulation management.
- Current imaging methods like CT and MRI pose limitations regarding cost, radiation, and time.
Purpose of the Study:
- To introduce and evaluate a novel technique for detecting and quantifying residual or recurrent cSDH using point-of-care ultrasound (US) and sonolucent burr-hole covers.
- To compare the efficacy of this US-based method with traditional head CT scans in postoperative cSDH patients.
Main Methods:
- A prospective and retrospective analysis of clinical and radiographical data from nine cSDH patients treated with burr-hole evacuation and sonolucent covers.
- Postoperative follow-up involved direct comparison of point-of-care US with head CT (gold standard).
- Image analysis measured hematoma thickness and implant-to-cortical distance using ImageJ and Unity PACS.
Main Results:
- The novel US technique demonstrated 100% concordance with CT in assessing cSDH resolution or recurrence.
- Both US and CT identified recurrent cSDH in one patient; the remaining seven showed resolution.
- No immediate or short-term complications or infections were associated with the sonolucent covers.
Conclusions:
- Point-of-care ultrasound, combined with sonolucent burr-hole covers, is a promising tool for postoperative cSDH evaluation.
- This method shows high concordance with CT, offering a potentially faster, radiation-free alternative for monitoring.
- US may serve as a valuable supplemental imaging modality in the management of chronic subdural hematoma.
Abstract:
Chronic subdural hematoma (cSDH) is predicted to become the most common neurosurgical pathology by 2030. Surgical evacuation is a critical component of cSDH management, and postoperative monitoring is important given high recurrence rates and concerns related to restarting anticoagulation. Given issues related to cost, radiation exposure, and time for computerized tomography (CT) and magnetic resonance imaging examinations, we developed a novel technique to detect, assess, and quantify residual and/or recurrent subdural hematoma with point-of-care, hand-held ultrasound and sonolucent burr-hole covers placed during the initial surgery. We prospectively collected and retrospectively analyzed clinical and radiographical data for cSDH patients treated with burr-hole evacuation and implanted sonolucent burr-hole covers. Postoperative outpatient follow-up included direct comparison of point-of-care ultrasound (US) and head CT as the gold standard. Implant-to-cortical distance and absolute hematoma thickness were measured using ImageJ and Unity PACS on follow-up scans. Nine patients underwent burr-hole evacuation of cSDH with placement of a sonolucent cover. Hematoma thickness and cover-to-septum pellucidum distance did not differ between the two techniques. Both US and CT detected recurrent subdural hematoma in one of the nine patients. US and CT showed resolution of cSDH for the remaining seven subjects at follow-up, demonstrating 100% concordance between the US and CT methods. No immediate or short-term complications and infections related to the use of the sonolucent cover were noted in this cohort. Ultrasound-based assessment using a sonolucent burr-hole cover showed good concordance with CT for detecting and ruling out recurrent cSDH in a small cohort of patients. Point-of-care US could become a supplemental imaging modality for postoperative evaluation of cSDH.
