Intraoperative neurosurgical ultrasound: transdural and transfontanelle applications

High-resolution real-time ultrasound scanning of 54 patients was performed with a sector scanner during a variety of neurological procedures. Scans obtained at the time of craniotomy were successful in characterizing and localizing tumors, abscesses, arteriovenous malformations, and hematomas within the brain of 15 of 16 adult patients. One attempt to visualize a brain cyst through a 15-mm burr hole was unsuccessful. Scanning of 37 infants and young children was performed through the anterior fontanelle during placement of ventricular shunts. This allowed for the accurate placement of shunts in all patients and resulted in fewer short-term and long-term complications. Intraoperative ultrasound is a practical and highly effective means of providing intraoperative localization of intracranial anatomy and disease.