Transcranial Ultrasound for Cranioplasty

Overseen By Tamika Wong, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northwell Health

Disqualifiers: Pregnancy

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

50 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial is testing a new way to use ultrasound to look inside the brain through a special see-through part of the skull in patients who have had skull repair surgery. This method aims to be safer and easier than traditional brain imaging techniques like CT and MRI scans.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Transcranial Ultrasound for Cranioplasty?

Research shows that using transcranial Doppler ultrasonography (a type of ultrasound) can help monitor changes in blood flow in the brain before and after surgeries like cranioplasty. This method is noninvasive and has been useful in assessing improvements in brain blood flow and predicting clinical outcomes after surgery. ^{1 2 3 4 5}

Is transcranial ultrasound generally safe for humans?

Transcranial Doppler ultrasound (TCD) is a noninvasive procedure widely used in neurology and neurosurgery to monitor blood flow in the brain. It is considered safe and is commonly used in various settings, including during surgery and in emergency situations, without significant safety concerns reported. ^{6 7 8 9 10}

How is transcranial ultrasound for cranioplasty different from other treatments?

Transcranial ultrasound for cranioplasty is unique because it uses sonolucent (ultrasound-transparent) cranial implants to allow ultrasound imaging of the brain after surgery, providing a non-invasive way to monitor brain health at the bedside. This approach differs from traditional methods that require direct access to the brain during surgery for imaging. ^{8 9 11 12 13}

Research Team

Netanel Ben-Shalom, MD

Principal Investigator

Lenox Hill Hospital

Eligibility Criteria

This trial is for men and women aged 18 or older who are undergoing reconstructive sonolucent cranioplasty as standard care. Participants must be willing to follow study procedures and be available for the entire study duration. Pregnant individuals cannot participate.

Inclusion Criteria

You have provided a signed and dated declaration of consent.

I am having a skull reconstruction with a transparent implant as part of my treatment.

I am 18 years old or older.

Exclusion Criteria

Patients who are pregnant

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Ultrasound imaging performed using FDA-approved devices to assess feasibility and efficacy compared to standard postoperative imaging

12 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Transcranial Ultrasound

Trial Overview The trial is observing how transcranial ultrasound works when used through a sonolucent (sound-transparent) material during cranioplasty, which is skull reconstruction surgery. It's an open-label study, meaning everyone knows what treatment they're getting.

Participant Groups

Group I: Transcranial Ultrasound Experimental Treatment 1 Intervention

Ultrasound imaging will be performed by clinicians using FDA-approved ultrasound devices currently used in routine clinical practice.

Who Is Running the Clinical Trial?

Northwell Health

Lead Sponsor

Trials

481

Recruited

470,000+

Findings from Research

Transcranial Doppler ultrasonography (TCD) is a safe, noninvasive, and cost-effective method for assessing intracranial pressure (ICP) in children with craniosynostosis, evaluated in a study of 16 children.

While TCD did not correlate well with traditional ICP measurements or CT findings, a decrease in the pulsatility index (PI) after surgery was clinically useful, indicating successful decompression, while an increase in PI post-surgery was a concerning sign.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The value of transcranial Doppler ultrasonography in craniosynostosis. Govender, PV., Nadvi, SS., Madaree, A.[2019]

In a study of 11 children with craniostenosis, decompression surgery significantly improved cerebral blood flow velocities in younger patients (ages 0-3 and 4-7), indicating enhanced cerebral hemodynamics post-surgery.

Transcranial Doppler sonography (TCD) proved to be an effective noninvasive method for monitoring changes in cerebral blood flow, demonstrating that surgery had a positive impact on blood flow parameters, particularly in younger children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preoperative and postoperative transcranial Doppler sonographic evaluations of the cerebral hemodynamics of craniostenosis. Wang, B., Cheng, Z., Mu, X., et al.[2016]

Decompressive craniectomy (DC) significantly reduces intracranial pressure (ICP) from an average of 37 mm Hg to 20 mm Hg immediately after the procedure, indicating its efficacy in managing severe traumatic brain injury (TBI).

The procedure also leads to improved cerebral blood flow, with diastolic velocities increasing and pulsatility index decreasing, suggesting a normalization of cerebral hemodynamics that lasts for at least 48 hours post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy. Daboussi, A., Minville, V., Leclerc-Foucras, S., et al.[2010]

Transcranial Doppler (TCD) ultrasonography can effectively predict outcomes in patients with severe traumatic brain injury, with significant correlations found between TCD measurements and intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

In a study of 96 patients, those with a mean blood flow velocity greater than 40 cm/s and a pulsatility index lower than 1.5 within the first 24 hours had better outcomes at 6 months, indicating that TCD can be a valuable tool in assessing the severity of brain injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcome prediction in severe traumatic brain injury with transcranial Doppler ultrasonography. Tan, H., Feng, H., Gao, L., et al.[2016]

In a study of 54 patients undergoing cranioplasty, 42.6% showed objective neurological improvement within 72 hours after the procedure, suggesting that cranioplasty may enhance brain function beyond cosmetic correction.

Post-surgery, there was a significant increase in cerebral blood flow (CBF) on both the defective side and the healthy side, with larger variations in the Lindegaard ratio indicating potential predictors of clinical improvement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography. Paredes, I., Castaño, AM., Cepeda, S., et al.[2018]

Using 3-dimensional graphical reconstructions of patients' skulls can significantly improve the success rates of transcranial Doppler ultrasound (TCD) procedures performed post-surgery, especially in challenging cases.

The image guidance not only enhances operator confidence but also reduces the time needed to complete the TCD, making it a valuable tool in postoperative care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Image guidance for rapid temporal acoustic window localisation prior to transcranial Doppler ultrasound in the neurosurgical patient. Lewis, PM., Goldschlager, T., Rosenfeld, JV.[2016]

In a study of 318 patients undergoing carotid endarterectomy (CEA), significant increases in middle cerebral artery flow velocity (MCAFV) were observed postoperatively, particularly in the first systolic peak (Sys1) and second systolic peak (Sys2), indicating improved blood flow to the brain.

The study found that while Sys1 and Sys2 increased significantly after surgery, diastolic flow velocity decreased, suggesting a normalization of arteriolar resistance, which could help identify potential complications like hyperperfusion syndrome in future assessments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Age corrected changes in intracranial hemodynamics after carotid endarterectomy. Schaafsma, M., Glade, GJ., Keller, PJ., et al.[2021]

Transcranial Doppler (TCD) ultrasonography is a valuable noninvasive tool for continuously monitoring cerebral blood flow (CBF) during surgery, which is crucial for patients at risk of cerebral ischemia.

The ongoing refinement of TCD technology aims to enhance its effectiveness and establish clear guidelines for its use as an intraoperative monitoring device.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intraoperative use of transcranial Doppler ultrasonography. Lam, AM., Newell, DW.[2016]

Transcranial Doppler ultrasonography (TCD) is an effective tool for assessing changes in cerebral blood flow, which is crucial for understanding both normal and abnormal brain function.

TCD can be used to measure cerebrovascular reactivity in response to various physiological and pathological stimuli, highlighting its importance in clinical evaluations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Investigation of cerebrovascular reactivity using transcranial doppler ultrasonography]. Sapieja, W.[2015]

Transcranial Doppler (TCD) ultrasonography is a valuable noninvasive tool for evaluating intracranial blood flow in patients with acute ischemic stroke, providing real-time hemodynamic information that can enhance treatment planning and monitoring.

TCD can monitor the effectiveness of thrombolysis treatments, such as tissue plasminogen activator (TPA), and has potential applications in detecting emboli and assessing cerebrovascular responses, making it essential in comprehensive stroke care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Role of transcranial Doppler ultrasonography in acute stroke. Sharma, VK., Venketasubramanian, N., Khurana, DK., et al.[2022]

Transcranial Doppler (TCD) ultrasound, when used alongside near-infrared spectroscopy (NIRS), can effectively identify different causes of cerebral desaturation during surgery, as demonstrated in a case involving a 69-year-old male patient undergoing heart surgery.

The study revealed that TCD can detect significant air emboli during episodes of brain desaturation, which were linked to acute right ventricular dysfunction, highlighting the importance of multimodal monitoring in improving patient safety and outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case report. Azzam, MA., Couture, EJ., Beaubien-Souligny, W., et al.[2021]

Transcranial Doppler (TCD) ultrasonography is a valuable tool in critical care for assessing cerebral blood flow, particularly in cases of cerebral vasospasm after subarachnoid hemorrhage, but its effectiveness in improving patient outcomes remains unclear due to a lack of randomized controlled studies.

Recent technological advancements in TCD, such as M mode and three-dimensional power Doppler, have expanded its applications beyond critical care, including the assessment of cerebral emboli and management of sickle cell disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applications of transcranial Doppler in the ICU: a review. White, H., Venkatesh, B.[2018]

Sonolucent cranial implants, particularly those made from clear poly-methyl-methacrylate (PMMA), allow for effective ultrasound imaging of the brain, providing a new way to monitor intracranial conditions post-surgery.

Intraoperative and postoperative ultrasound evaluations demonstrated that these implants can reveal detailed ventricular anatomy and detect complications like epidural fluid collections, suggesting their potential for real-time monitoring of brain health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sonolucent Cranial Implants: Cadaveric Study and Clinical Findings Supporting Diagnostic and Therapeutic Transcranioplasty Ultrasound. Belzberg, M., Shalom, NB., Yuhanna, E., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

The value of transcranial Doppler ultrasonography in craniosynostosis. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Preoperative and postoperative transcranial Doppler sonographic evaluations of the cerebral hemodynamics of craniostenosis. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy. [2010]

4. China pubmed.ncbi.nlm.nih.gov

Outcome prediction in severe traumatic brain injury with transcranial Doppler ultrasonography. [2016]

5. United States pubmed.ncbi.nlm.nih.gov

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography. [2018]

6. England pubmed.ncbi.nlm.nih.gov

Image guidance for rapid temporal acoustic window localisation prior to transcranial Doppler ultrasound in the neurosurgical patient. [2016]

7. Italy pubmed.ncbi.nlm.nih.gov

Age corrected changes in intracranial hemodynamics after carotid endarterectomy. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Intraoperative use of transcranial Doppler ultrasonography. [2016]

9. Poland pubmed.ncbi.nlm.nih.gov

[Investigation of cerebrovascular reactivity using transcranial doppler ultrasonography]. [2015]

10. India pubmed.ncbi.nlm.nih.gov

Role of transcranial Doppler ultrasonography in acute stroke. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case report. [2021]

12. United States pubmed.ncbi.nlm.nih.gov

Applications of transcranial Doppler in the ICU: a review. [2018]

13. United States pubmed.ncbi.nlm.nih.gov

Sonolucent Cranial Implants: Cadaveric Study and Clinical Findings Supporting Diagnostic and Therapeutic Transcranioplasty Ultrasound. [2023]