Ultrasound-guided ventricular puncture during cranioplasty.

Abstract Background In patients with brain parenchyma extending beyond the craniectomy defect, cerebrospinal fluid diversion may be necessary to facilitate proper bone flap replacement during cranioplasty. In this study, we present our case series of patients who underwent ultrasound-guided ventricular puncture during cranioplasty, and report periprocedural metrics and clinical outcomes. Methods A retrospective study was performed of patients who presented for cranioplasty that required ultrasound-guided ventricular puncture. We also describe our operative technique for safely and accurately performing ultrasound-guided ventricular puncture. Results Ten consecutive patients were included in the overall patient cohort, all of whom required intraoperative ventricular puncture to achieve brain relaxation. The mean time between decompressive hemicraniectomy and cranioplasty was 145.4 days (range 19–419). The mean duration of cranioplasty operation was 146 minutes (range 74–193). All patients underwent ultra-sound guided ventricular puncture, and 5 patients had an external ventricular drain left in place for post-operative intracranial pressure monitoring and possible cerebrospinal fluid drainage. There were no instances of peri-catheter hemorrhage. One patient presented post-operatively with wound infection, and this same patient was the only patient in the cohort that required subsequent ventriculoperitoneal shunt for symptomatic hydrocephalus. Conclusion Ultrasound-guided ventricular puncture is safe, feasible and efficacious for use during cranioplasty to help facilitate bone flap replacement in patients with ‘full’ brains, with an overall low rate of associated periprocedural complications. Although further studies are needed in a larger patient cohort, this technique should be considered to help reduce the morbidity associated with cranioplasty.