Abstract Introduction Ultrasound (US) is a widely used tool by neuro-anesthesiologists due to its easy availability that allows a quick bedside assessment of the patient’s condition, providing helpful information of prognosis and diagnosis (1). One of the most important uses of US in neuroanesthesia and neurocritical care is the identification of the intracranial cerebral blood vessels through Transcranial Doppler (TCD), which permits the evaluation of the cerebral blood flow velocity (CBFV) (1). Another use includes the guidance of the positioning of the external ventricular drains (EVD). Although it is one of the most frequently performed neurosurgical procedures, its placement technique has not been standardized, which is associated with catheter misplacement and malfunction. Case report A one-month-old male infant, born at term, with a history of myelomeningocele requiring surgical correction of spinal cord malformation, presented a cerebrospinal fluid fistula as a post-surgical complication, leading to neuroinfection. The patient exhibited neurological compromise secondary to meningitis with active hydrocephalus and super-refractory status epilepticus. To manage the hydrocephalus and improve neurological prognosis, a ventriculostomy was performed. Transcranial US was used throughout the procedure to guide the correct placement of the EVD and gave significant information of the blood flow velocities measured by the Pulsed Wave (PW) doppler; before and after the surgery was performed. The EVD was displaced during the procedure, and with US guidance it was possible to direct its correct positioning again (A, B). Additionally, the elevated peak systolic (PS) velocity, end systolic (ED) velocity and the resulting pulsatility index (IP) may correlate to an elevated intracranial pressure (ICP), which showed marked improvement after accurate the placement of the ventriculostomy (C, D). Discussion Ultrasound guided EVD placement has been proposed as a reliable and precise alternative that could simplify the procedure by facilitating the proper positioning and reducing the risk of the catheter malfunction. Transcranial US is an accessible and noninvasive tool that provides real-time significant information about the dynamic cerebral blood flow, allowing intraoperative neurovascular diagnosis through practical neuronavigation; it can help with surgical decisions and confirm the immediate effectiveness of the intervention. References: 1. Bidkar PU, Kannabiran N, Chatterjee P. Clinical applications of ultrasound in neurosurgery and neurocritical care: A narrative review. Med J Armed Forces India. 2024;80(1):16-28. doi:10.1016/j.mjafi.2023.06.007 This abstract is funded by: None
Coronell et al. (2026) studied this question.