Visualisation of intracranial aneurysms by transcranial duplex sonography

We examined 72 patients with 89 angiographically confirmed intracranial aneurysms, using transcranial colour-coded duplex sonography (TCCD) to determine the location and size of the aneurysm. The patients were admitted for coil embolisation of their aneurysm following subarachnoid haemorrhage or because of a cranial nerve palsy. Using a 2/2.25 MHz transducer, 42 aneurysms (47%) were seen satisfactorily through the temporal bone window or foramen magnum. In 24 cases (27%) image quality was insufficient as a result of a poor bone window, of the aneurysm having a diameter of less than 6 mm or of its being in an unfavorable location. In 23 other cases (26%) it was not possible to detect the aneurysm. Thrombosed structures could be demonstrated using TCCD in 8 of 12 giant intracavernous or basilar artery aneurysms, and in 15 of 19 aneurysms treated by platinum coil embolisation. TCCD offers a noninvasive method for monitoring progressive intra-aneurysmal thrombosis following coil embolisation and for follow-up of patients with untreatable fusiform aneurysms, should this be required. Detection of small aneurysms is limited by spatial resolution and insonation angles.