Perioperative transcranial Doppler US to evaluate intracranial compliance in young children undergoing craniosynostosis repair surgery.
OBJECTIVE
To determine whether measurements with transcranial Doppler ultrasonography (US) of resistive indexes (RIs) of basal cerebral arteries with pressure provocation can be used to identify infants and children with craniosynostosis who have abnormal intracranial compliance and to study the effects of surgery on compliance.


METHODS
Transcranial Doppler US was performed through the temporal squama, fontanels, and existing skull defects prior to and immediately following cranioplasty. Twenty-four studies were performed in six patients with multisuture synostosis, and 61 studies were performed in 26 patients with single-suture synostosis. Study findings were compared with those of 23 control subjects and were characterized as normal or abnormal on the basis of age-specific normal criteria for RI.


RESULTS
In multisuture synostosis, results of six of the nine preoperative transcranial Doppler US studies were abnormal. During postoperative follow-up, three recurrences requiring reoperation occurred, one of which was detected with abnormal transcranial Doppler US findings. In single-suture synostosis, results of seven of the 26 preoperative transcranial Doppler US studies were abnormal, and all occurred in young infants with sagittal and unicoronal synostosis. Immediate effects of surgery were variable. All patients with sagittal synostosis had a significant immediate postoperative increase in RI, which normalized during postoperative follow-up. There was no significant difference in RI between patients with successfully treated craniosynostosis and control subjects.


CONCLUSIONS
Transcranial Doppler US can be used to identify patients with craniosynostosis with decreased intracranial compliance, and it is a suitable noninvasive test to monitor the effects of surgery on compliance.
Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA, USA. SWestra@childrensmemorial.org
S J
SJ
Westra
M A
MA
Stotland
J
J
Lazareff
C T
CT
Anderson
J W
JW
Sayre
H
H
Kawamoto
D002675:Child, Preschool; D003187:Compliance; D003398:Craniosynostoses / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012015:Reference Standards; D012886:Skull / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods