Sonolucent Cranial Implants: A Window into the Future of Management of Neurosurgical Patients? A Systematic Review and Cost Analysis.

Background: Computeed tomography (CT) is a cornerstone of the identification and management of acute changes in neurosurgery patients. In addition to the monetary expense of CT scans, further costs are incurred due to the time of patient transport and radiation exposure. Ultrasounds (USs)offer a safe, inexpensive, and bedside alternative to CT but obstacles remain due to decreased penetrance in the adult skull. Sonolucent Cranial Implants (SCIs) offer a window for USs to view intracranial architectures.

Methods: The authors performed a PRISMA guidelines-based systematic review of the literature. Information was extracted from included articles in regards to illness pathology, US imaging feasibility, comparison to standard imaging, infections, and revisions. Costs were collected in regards to price of implant and follow-up imaging.

Results: A total of 226 articles resulted, of which 5 were included in the study. Ninety non-duplicate patients who received SCIs were analyzed. The pathologies of included patients is as follows: 51 patients were after extracranial-intracranial bypass, 37 after ventriculoperitoneal shunt placement for hydrocephalus, 1 after tumor resection, and 1 after cranioplasty following decompressive hemicraniectomy. All studies noted feasibility of US and comparability to standard imaging following SCI placement. Follow-up imaging with trans-sonolucent cranial implant ultrasound was estimated to save up to $4,000 per patient depending on the procedure.

Conclusions: Initial studies suggest that US imaging through SCIs is a safe and efficacious alternative to CT imaging in neurosurgical patients. Cost analysis suggests that SCI and subsequent US can offer a cost savings compared with current treatment.