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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Is ultrasound a possible alternative to CT-scan in intensive care patients with decompressive hemicraniectomy?

Ist Ultraschall eine mögliche Alternative zum CT-Scan bei Intensivpatienten mit dekompressiver Hemikraniektomie?

Meeting Abstract

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  • Andrea Cattaneo - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Alexandra Beez - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Christoph Wipplinger - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Kevin Lamllari - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Almuth F. Keßler - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Thomas Linsenmann - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Christian Stetter - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Ekkehard Kunze - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Thomas Westermaier - Helios Amper-Klinikum Dachau, Neurochirurgie, Dachau, Deutschland
  • Mario Löhr - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • presenting/speaker Judith Weiland - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV259

doi: 10.3205/22dgnc251, urn:nbn:de:0183-22dgnc2518

Published: May 25, 2022

© 2022 Cattaneo et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Decompressive hemicraniectomy (DC) is the surgical therapy of choice in cerebral edema due to trauma, subarachnoid hemorrhage, and stroke. Patients in critical phase often need a frequent imaging control. Bedside ultrasound (US) may be a possible alternative to the conventional diagnostic methods as computer tomography (CT) and may help to reduce the number of transports and CT-scans. The aim of this observational pilot study is to assess the agreement between CT-scan and bedside transcranial sonography in patients after decompressive craniectomy.

Methods: 55 patients with DC after trauma (18), SAH (16), stroke (11) and before cranioplasty after DC (10) were scanned by bedside ultrasound (Siemens acuson x700), using the 4V1c the 4C1 transducer with penetration depth of 10 to 18 cm in coronal and axial level, starting on the first postoperative day analogous to scheduled first CT-Scan. Midline shift, edema and extent of hemorrhage were measured in millimeters and these data correlated with measurements of the CT-scans. Moreover, we measured maximum bifrontal diameter, bicaudate diameter, Cella media, 3. Ventricle width as parameters for the ventricular system. Levene index, bifrontal index and the bicaudate index were calculated.

Results: In our study, we included 55 patients, 29 females and 26 males with a mean age of 47.7 years. Our group of patients underwent a mean of 6.9 control CT-scans during the hospital stay and a mean of 4.3 CT-scans from the date of craniectomy. The measured changes in ventricular width as well as midline shift as indirect signs for edema in ultrasound correlated positive in all cases with the results of the CT-scans (p < 0.001). The mean difference between CT-scans and US in all the measured parameter for the ventricle system was 1,07mm (SD 2,3 mm).

Conclusion: The results of this single center observational pilot study suggest that bedside ultrasound appear to be a sufficient fast diagnostic technique to monitor the course of intracranial pathologies as well as a very precise method to measure the intracranial ventricular system. Different questions usually addressed to CT can be answered with similar accuracy by bedside US. The reduction of CT-scans has also the positive effect of reduced radiation exposure and costs. Thus, the number of potentially risky intrahospital transports may be reduced. Further prospective trials are necessary to confirm these promising results.