Venous intracranial haemodynamics in children undergoing operative treatment for the repair of craniosynostosis. A prospective study using transcranial colour-coded duplex sonography.

To evaluate intracranial venous haemodynamics in craniosynostosis noninvasively, we measured the blood flow velocities and pulsatility indices in the superior sagittal sinus (SSS) and the middle and the anterior cerebral artery during the perioperative course in 21 children undergoing repair of craniosynostosis involving the midline sutures, using transcranial colour-coded duplex sonography (TCCS). An age-matched group of 12 healthy children was examined in like manner for comparison. In the healthy group, the mean pulsatility index (PI) in the SSS was 0.22 and the mean resistance index (RI) 0.20. The mean preoperative PI and RI in the synostosis group were significantly higher [0.41 and 0.34, respectively (P<0.01)], but fell to 0.19 and 0.17 (P<0.01) in the postoperative course. Our results indicate that in craniosynostosis there is an altered venous haemodynamics in the SSS, which can be observed noninvasively by TCCS.

The value of transcranial duplex sonography in the management of patients subsequent to surgery for middle cerebral artery aneurysms.

OBJECTIVE: We intended to evaluate the value of transcranial color-coded duplex sonography (TCCS) in the management of patients after clipping of an aneurysm of the middle cerebral artery. Question was whether this method was able to predict poor clinical outcome by detection of local circulation disorders in the postoperative course. METHODS: A series of 15 consecutive patients was examined daily by TCCS. Special attention was paid to the branches of the middle cerebral artery distal from the clip (M2 branches). We correlated the TCCS results to the clinical outcome and occurrence of infarction on CCT. RESULTS: In six patients, one or more M2 branches could not be found in the immediate postoperative course, but reappeared after a period of 1-12 days in five patients. The three patients with a missing signal for more than 4 days suffered from infarction of the dependent territory and permanent neurological deficit not due to vasospasm of the middle cerebral artery. In the nine patients with constant TCCS signals, there was only one infarction due to pre-hospital systemical hypotension. CONCLUSION: TCCS cannot give exact postoperative information about incidental vessel occlusion during surgery for MCA aneurysms because M2 branches can remain invisible for some days without being occluded, but this invisibility seems to be coupled with ischemic complications.