Intraoperative Echo in TBI

Abstract

Traumatic brain injuries (TBIs) are common neurosurgical emergencies that, in many cases, require fast decision-making and surgical management. In particular, the surgical strategy in these cases may unpredictably be modified because traumatic brain lesions may change over time from the first radiological picture to the time of surgery. For this reason, real-time imaging may offer the opportunity to overcome such problems and help neurosurgeons to get a quick management of intraoperative problems related to unexpected evolution of traumatic brain lesions. One of the most useful instruments can be the intraoperative ultrasound (ioUS) that can allow to have an immediate picture of both surgical site and contralateral site. Despite the efficient performance of ioUS, in literature the use of such instruments during surgery for TBIs is underestimated and this fact may be related with many reasons like lack of routinary use, difficulty in introducing a new instrument in the emergency setting, or lack of a constant use during elective cases and possible misinterpretations of the scans. In this chapter we are dealing with the possible roles for ioUS in the management of TBIs in terms of actual knowledge and possible future perspectives with advanced imaging. This chapter is also meant to be used as a brief guide for those who are interested in introducing the routinary use of iOUS in the management of TBI.