Article
Transcranial and transorbital ultrasound guiding ICP-management
Transkranieller und transorbitaler Ultraschall als Kontrolle der Hirndrucktherapie
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Authors
Published: | April 23, 2004 |
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Outline
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Objective
Initial CT-imaging of the brain-injured patient is almost indispensible for further treatment decisions. But whereas neurotraumatic injuries are frequently associated with severe pulmonary disorders, transportation for CT-imaging may be life-threatening for the patient. Especially in the postoperative period, it may not even be feasible. In this context we present our experience with transcranial and transorbital ultrasound.
Methods
While CT-imaging was routinely performed, supplemental transcranial PW-doppler, transcranial and transorbital B-scan ultrasound were carried out in the postoperative course of 26 brain-injured patients. Sonographic results were correlated to ICP data.
Results
Intracerebral hemorrhages, midline shifts and enlargement of the ventricles were easily and reliably detected by transcranial B-scan. Further analyses were limited by the temporal bone window. Transorbital measurements of the prominence of the papilla (1mm as an equivalent of 1 diopter), the diameter of the optic nerve (normal range 2.7-5mm) and the width of the third ventricle (2.9-7.5mm) are reliable parameters to verify a raised ICP or local changes of cerebral disorders. These results correlated significantly with the well-known PW-doppler findings where a lowering of the systolic amplitude and a diminution of the diastolic pulse curve sensitively verifies a raised ICP.
Conclusions
We conclude that transcranial and transorbital ultrasound imaging is of great significance in the postoperative period extending the possibilities of neurointensive monitoring. As intracerebral hemorrhages and other mass effects can be reliably excluded by transcranial ultrasound, CT-imaging of the narcotized brain injured patient may be postponed and life-threatening transportation avoided. Transorbital ultrasound has been underestimated so far, however, its potential role is impressively documented by ICP measurements which correspond well with the TCD and the intraparenchymatous ICP data.