The value of transcranial Doppler ultrasonography in craniosynostosis

Some children with craniosynostosis demonstrate raised intracranial pressure (ICP), requiring surgical decompression. Conventional methods of measuring ICP in such children are invasive, expensive, and require expertise. Transcranial Doppler ultrasonography (TCD) is an alternative, useful means of assessing ICP qualitatively, and is noninvasive, inexpensive, and safe. We evaluated the use of TCD prospectively in 16 children with craniosynostosis and correlated TCD findings with intraoperative ICP measurements by lumbar puncture (LP) and with computed tomographic (CT) findings. TCD evaluations were performed before and after surgery to determine the pulsatility index (PI), which is known to show close correlation with ICP. The three modalities--TCD, ICP, and CT--showed poor correlation with each other. However, the fall in the PI value after surgery, as determined by TCD, was shown to be clinically useful, with a rise in the PI value after surgery being an ominous sign.