Perioperative transcranial Doppler US to evaluate intracranial compliance in young children undergoing craniosynostosis repair surgery

PURPOSE: To determine whether measurements with transcranial Doppler ultras onography (US) of resistive indexes (Rls) of basal cerebral arteries with p ressure provocation can be used to identify infants and children with crani osynostosis who have abnormal intracranial compliance and to study the effe cts of surgery on compliance. MATERIALS AND METHODS: Transcranial Doppler US was performed through the te mporal squama, fontanels, and existing skull defects prior to and immediate ly following cranioplasty. Twenty-four studies were performed in six patien ts with multisuture synostosis, and 61 studies were performed in 26 patient s with single-suture synostosis. Study findings were compared with those of 23 control subjects and were characterized as normal or abnormal on the ba sis 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 det ected with abnormal transcranial Doppler US findings. In single-suture syno stosis, results of seven of the 26 preoperative transcranial Doppler US stu dies were abnormal, and all occurred in young infants with sagittal and uni coronal synostosis. immediate effects of surgery were variable. All patient s with sagittal synostosis had a significant immediate postoperative increa se in RI, which normalized during postoperative followup. There was no sign ificant difference in RI between patients with successfully treated cranios ynostosis and control subjects. CONCLUSION: Transcranial Doppler US can be used to identify patients with c raniosynostosis with decreased intracranial compliance, and it is a suitabl e noninvasive test to monitor the effects of surgery on compliance.