Transcranial sonography for monitoring hydrocephalus

Transcranial sonography (TCS) is widely used to evaluate brain structures and intracranial vessels, with recent developments allowing high-resolution and dynamic imaging. Color-coded duplex sonography is mostly used to investigate the basal cerebral arteries and plays an important role in stroke diagnostics¹ and in intensive care medicine,² while B-mode sonography is generally used for evaluation of the brain parenchyma. Transcranial B-mode sonography emerged in the early 1990s and is in widespread use, especially for neurosurgical intraoperative imaging³ and, to a lesser extent, for evaluation of neurodegenerative diseases and brain tumors.^4,5 In the neurologic intensive care setting, TCS allows the assessment of the size and location of intracerebral hemorrhages (hematoma volume) as well as visualization and monitoring of midline shift in these lesions with comparisons among consecutive studies.^6,7

The main advantages of TCS are its noninvasiveness and suitability for bedside imaging. Furthermore, for patients who are unable to cooperate with other imaging modalities, TCS may be an option because the investigator and the patient are in continuous contact. TCS also offers the possibility of repeated imaging under real-time conditions and as clinical conditions change, with relatively low …