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Sonolucent Cranial Implants

Cadaveric Study and Clinical Findings Supporting Diagnostic and Therapeutic Transcranioplasty Ultrasound

Belzberg, Micah, BA*; Shalom, Netanel Ben, MD; Yuhanna, Edward, BA, RDMS; Manbachi, Amir, PhD‡,§; Tekes, Aylin, MD; Huang, Judy, MD; Brem, Henry, MD; Gordon, Chad R., DO*,†

doi: 10.1097/SCS.0000000000005454
Original Article: PDF Only

Background: Previously, sonographic evaluation of the intracranial contents was limited to intraoperative use following bone flap removal, with placement of the probe directly on the cortical surface or through a transsulcal tubular retractor. Cranioplasty with sonolucent implants may represent a postoperative window into the brain by allowing ultrasound to serve as a novel bedside imaging modality. The potential sonolucency of various commonly used cranial implant types was examined in this study.

Methods: A 3-phase study was comprised of cadaveric evaluation of transcranioplasty ultrasound (TCU) with cranioplasty implants of varying materials, intraoperative TCU during right-sided cranioplasty with clear implant made of poly-methyl-methacrylate (PMMA), and bedside TCU on postoperative day 5 after cranioplasty.

Results: The TCU through clear PMMA, polyether-ether-ketone, and opaque PMMA cranial implants revealed implant sonoluceny, in contrast to autologous bone and porous-polyethylene. Intraoperative ultrasound via the clear PMMA implant in a single patient revealed recognizable ventricular anatomy. Furthermore, postoperative bedside ultrasound in the same patient revealed comparable ventricular anatomy and a small epidural fluid collection corresponding to that visualized on an axial computed tomography scan.

Conclusion: Sonolucent cranial implants, such as those made of clear PMMA, hold great promise for enhanced diagnostic and therapeutic applications previously limited by cranial bone. Furthermore, as functional cranial implants are manufactured with implantable devices housed within clear PMMA, the possibility of utilizing ultrasound for real-time surveillance of intracranial pathology becomes much more feasible.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

*Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD

Department of Radiology, Johns Hopkins Hospital, Baltimore, MD

§Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD

Division of Pediatric Radiology and Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Chad R. Gordon, DO, FACS, Director, Neuroplastic and Reconstructive Surgery, Associate Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, JHOC, 8th Floor, 601 N Caroline St, Baltimore, MD 21287; E-mail:

Received 19 December, 2018

Accepted 9 February, 2019

CG is a consultant for Stryker and Longeviti Neuro Solutions. JH and CG are stockholders of Longeviti Neuro Solutions. The remaining authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.