Diagnostic performance of bedside transcranial ultrasound after decompressive craniectomy: a comparative study with cranial computed tomography.

OBJECTIVE

The aim of this study was to evaluate the diagnostic effectiveness and accuracy of bedside transcranial ultrasonography performed through the craniectomy in diagnosing typical post-decompressive craniectomy (DC) complications, using cranial CT as the reference standard.

METHODS

This retrospective study analyzed 88 consecutive patients who underwent DC between January 2023 and December 2024. In each case, bedside transcraniectomy ultrasonography (BTUS) was performed prior to CT imaging, and findings from both modalities were compared. Diagnostic agreement was evaluated using Cohen's kappa coefficient. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for BTUS in identifying complications, including hematomas, hygroma, hydrocephalus, abscess, edema, and midline shift.

RESULTS

BTUS has high diagnostic accuracy compared with CT, with overall sensitivities ranging from 59.4% (edema) to 100% (hematomas) and specificities between 94.2% and 100%. Strong or almost perfect agreement (κ > 0.8) was observed for most complications. The rate of false negatives was lowest for space-occupying lesions and highest for diffuse pathologies, such as edema. Negative predictive values remained above 80% for all major complication types.

CONCLUSIONS

BTUS provides a rapid, noninvasive, and readily available tool for the initial detection and monitoring of postcraniectomy complications. While it does not entirely replace CT in complex cases, it holds significant potential as a first-line screening and monitoring modality in neurosurgical intensive care settings. Bedside ultrasonography can significantly reduce reliance on CT scans, particularly in unstable or radiation-sensitive patients. Incorporating routine BTUS into post-DC monitoring protocols could enhance patient safety, expedite diagnosis, and optimize resource utlization in neurocritical care.