Ultrasonography for Serial Monitoring and Management of CSF Dynamic Disorders After Decompressive Craniectomy

Abstract Objective Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following severe head injury. However, impairments of cerebrospinal fluid (CSF) hydrodynamics such as hydrocephalus and subdural effusion are common complications that occur after DC. Therefore, monitoring of intracranial pressure is a staple of neurocritical care post-DC. The aim of this study was to assess the usefulness of transcranial duplex sonography (TDS) for serial monitoring and management of CSF disorders after DC. Methods A total of 100 patients who underwent DC between June 2016 and May 2019 were recruited for the study. TDS examinations were performed between 1 day and 1-year post-DC. TDS was mainly used for monitoring changes in ventricle size and morphology, and also to monitor intraventricular hemorrhage (IVH), hydrocephalus, intracranial hygromas, and ventricle changes during CSF release procedures. Results A total of 456 TDS examinations were performed on patients after DC. Of these, 402 were performed in the neuro-ICU. Two patients had IVH and underwent TDS-guided external ventricular drainage (EVD). Twenty-nine patients were diagnosed with hydrocephalus. The results of TDS were consistent with those of cranial computed tomography (CCT). Three cases of ventriculoperitoneal shunt and 1 case of lumbar peritoneal shunt underwent valve pressure reset according to TDS, in order to obtain satisfactory ventricle size. TDS was used to monitor ventricle changes and control drainage volume during CSF release procedures, including 2 EVD, 6 external lumbar drainage, and 10 lumbar punctures. Eighteen patients were detected with single or multiple intracranial effusions, including 16 subdural hygromas, 5 longitudinal fissure hygromas, and 6 brain cysts. Conclusions TDS can efficiently help monitor changes in ventricle size and morphology and intracranial effusions. Due to its noninvasive nature, suitability for bedside application, real-time and inexpensiveness, TDS can significantly replace CCT and become part of the patient's daily inspection work after DC.