Bedside Ultrasound After Decompressive Craniectomy: A New Standard?

Excerpt

Evaluation of brain structures represents a vital element of the practice in a neurointensive care unit. Several monitoring techniques may be used to guide crucial therapeutic decisions. Currently, repeated computed tomography (CT) is used to monitor progression (or improvement) in patients with intracerebral hemorrhage (ICH) or cerebral ischemia. CT allows rapid assessment of brain pathology, especially to evaluate hematoma and ventricular size, edema progression, ischemic infarcts, and midline shift. However, transferring an instable or intubated patient to the CT-scanner may be a time- and resource-consuming task. Portable CT scanning in the intensive care unit (ICU) is equally costly and not universally available. Because of its bedside application, ultrasound has become increasingly popular in the neuro-ICU [1, 2]. Advantages of sonography are its noninvasive technique, portability, and possibility of fast interpretation. Several studies indicated that it is possible to evaluate cerebral anatomy as well as hematomas and ventricular enlargements [3, 4]. However, the ultrasound technique is dependent upon the examiner’s experience [1]. Moreover, skull thickness and bone density often limit the image quality achievable by ultrasonography. Patients after decompressive craniectomy may present an ideal candidate to visualize intracerebral anatomy with a high resolution. A few studies suggested that the sonographic technique might be considered an alternative to CT in monitoring these patients [5]. …