To analyze the safety and feasibility of elective sonolucent cranioplasty in the setting of extra- to intracranial (EC-IC) bypass surgery to monitor bypass patency using ultrasound.
Patients who underwent direct EC-IC bypass surgery agreed to sonolucent cranioplasty at the time of surgery and received a sonolucent polymethyl methacrylate (PMMA) implant. Besides monitoring clinical outcome, all patients received trans-cranioplasty ultrasound (TCUS) on postoperative day 1 and at last follow-up. In addition, bypass patency was confirmed using catheter angiogram and fit of implant using computed tomography (CT). Patient-rated outcome was assessed through phone-questionnaire.
EC-IC bypass surgery with PMMA cranioplasty was successful in all 7 patients with patent bypasses on postoperative angiogram. Direct TCUS was feasible in all patients and bypass patency was monitored. There were no complications such as postoperative hemorrhagic/ischemic complications related to the bypass procedure in this patient population as well as also no complications related to the PMMA implant. Postoperative CT showed favorable cosmetic result of the PMMA implant both in the pterional area for STA-MCA bypasses as well as the parieto-occipital area for OA-MCA bypasses as confirmed by high rated overall patient satisfaction with favorable cosmetic, pain and sensory patient-rated outcome.
In this study we were able to show that this novel technique is safe, allows for patency assessment of the EC-IC bypass using bedside TCUS technique and is cosmetically satisfying for patients.

Copyright © 2020. Published by Elsevier Inc.
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