Image guidance for rapid temporal acoustic window localisation prior to transcranial Doppler ultrasound in the neurosurgical patient

Transcranial Doppler ultrasound (TCD) is a technically challenging procedure, when performed at the bedside in the postoperative period. Skull defects and acoustic obstacles were identified prior to TCD using 3-dimensional graphical reconstructions of patients' skulls after aneurysm surgery. We report our experiences, including a case wherein the technique facilitated completion of a successful TCD after conventional methods failed. We conclude that image guidance improves success rates, increases operator confidence and decreases procedural time for transcranial Doppler ultrasound.