Ultrasound as a Useful Tool in Hydrocephalus Management During Pregnancy: A Case Report

Abstract

A 38-year-old pregnant woman in her 24th week of gestation was admitted to our neurosurgical intensive care unit with a 5-cm cerebellar hemangioblastoma and acute hydrocephalus. Initial management included the placement of an external ventricular drain to prevent neurological deterioration. Five days after the initial diagnosis, the patient successfully underwent a neurosurgical intervention to remove the lesion. Transcranial ultrasound was used to determine the optimal ventricular drain level and facilitate weaning, bypassing the need for cerebral computed tomography and cerebral magnetic resonance imaging, which would have otherwise been necessary in postoperative follow-up. (A&A Practice. 2021;15:e01451.

Transcranial Ultrasound and Third Ventricle Inter-reliability: A Trick From Trigonometry

“…1 Examination of the diameter of the third ventricle is particularly useful to diagnose hydrocephalus 2 or as a follow up technique in already established ventricular enlargement. 3 Identification of the third ventricle with transcranial ultrasound is usually an easy task. After identifying the mesencephalic plane with a phased array probe through the transtemporal acoustic window, the operator has to perform a slight cranial tilt (usually around 10 degrees) of the probe to allow visualization of the diencephalic plane with the third ventricle.…”

“…1 This technique is incredibly successful in cooperative and relaxed patients when assessed and managed by a multidisciplinary team. 2,3 Awake sensorimotor and speech mapping are invaluable intraoperative tools providing neurosurgeons with assurance when operating in and around eloquent areas. Several mechanisms have been described in the literature of continuous assessment of speech areas, but nothing much has been mentioned about continuous motor function evaluation.…”

“…Transcranial ultrasound is used to examine brain structures through the skull’s acoustic windows and is a cornerstone among noninvasive cranial examinations 1. Examination of the diameter of the third ventricle is particularly useful to diagnose hydrocephalus2 or as a follow up technique in already established ventricular enlargement 3. Identification of the third ventricle with transcranial ultrasound is usually an easy task.…”

“…While the application of transcranial ultrasound as a follow-up tool is fascinating and could lead to a reduced need for cranial computed tomography with lower exposure to ionizing radiation,3 its use may be limited due to serious concerns about intermeasurement reliability. In particular, tilting the probe could alter the angle of insonation and artificially increase measured third ventricle diameter as insonation angle increases.…”