Transcranial ultrasonography to detect early intracranial complications post-decompressive craniectomy for stroke: A feasibility study

Objectives: The objectives of the study are to evaluate the feasibility of bedside transcranial ultrasonography (TCS) compared to computed tomography (CT) for detecting early post-operative complications in patients with stroke after decompressive craniectomy. Materials and Methods: A prospective observational study was conducted, involving patients undergoing decompressive craniectomy who were monitored using both TCS and CT. TCS was performed within 6-h post-surgery which was considered as baseline followed by every 12 h for the next 72 h. A routine CT at 24 h and as decided by the operating surgeon was done. Results: A total of 10 patients were studied. The majority had ischemic strokes (80%), while 20% had intraventricular hemorrhage. Complications were identified in four patients. The feasibility of acquiring interpretable TCS images was highest at 6-h post-surgery with a 90% success rate. This decreased to 70% at 12 h followed by a rate improved to 80% at 24 h but dropped again to 70% at 36 h, reflecting clinical variability. Full feasibility (100%) was achieved at 72 h. TCS demonstrated a sensitivity of 85.7% and a specificity of 100% to detect post-operative intracranial complications. Median operational times for TCS and CT were 3 min and 20 min, respectively. Conclusion: TCS offers a rapid, cost-effective, and radiation-free alternative to CT, potentially improving patient outcomes through timely diagnostic interventions, especially in resource-constrained settings.