gms | German Medical Science

Objective: Early brain death determination is necessary if organ transplantation is optional. Difficult cases of brain death diagnosis and decision making as well as aiming for early diagnosis need additional technical examinations. The transcranial highend triplex sonography, developed in neighbour disciplines, today offers a promising tool with new cababilities not well examined in neurosurgery. The goal was to examine the application in brain death determination and the possibility of early diagnosis by bed side imaging.

Methods: In 40 cases of brain death transcranial highend triplex sonography was applied and analyzed retrospectively. The ALOKA 5000 machine was used with a TCD probe (2.14 - 3.75 MHZ). Additional to the frontobasal, temporal and suboccipital window, transorbital approach and craniotomy defects were used. Examinations were started routinely as early as possible, optional before clinical brain death and all major vessel intracranially were examined.

Results: We found no single diagnosis of brain death determination by cerebral circulation arrest in contradiction to brain death protocol results, but several sonographic circulation presentations were seen. In such cases, after the second protocol of brain death diagnosis, different paradox circulation features were seen in the duplex mode which in most cases was a representation of pendel flow. However in the doubtless cases and in the complex cases the ultrasound assisted in decreasing time needed for brain death determination. Main limitation is the users experience and a sufficient ultrasound window of the skull.

Conclusions: Transcranial highend triplex sonography is a valuable tool in brain death determination and for early diagnosis. The actually ultrasound technique need to be more examined for its capacity in reducing diagnosis time of brain death determination.