Introduction Neurosurgery is a field which embraces innovation, yet, the use of ultrasound has been adapted more slowly than other specialties. Diagnostic ultrasound has several advantages, including low cost, point-of-care accessibility, and lack of radiation exposure. Recently, advances in types of cranioplasty implants are creating new windows to perform transcranial ultrasound.

Materials and Methods Consecutive patients who underwent decompressive hemicraniectomy (DHC) followed by cranioplasty with custom clear polymethyl methacrylate implant based on computed tomography were included. Postoperative sonography was performed and findings were recorded. Patient demographics including age, gender, indication, infection rate, and revision rates were analyzed.

Results Five consecutive patients (60% female, median age 57 years [IQR 46-62]) underwent cranioplasty. The underlying pathology prompting DHC was ruptured arteriovenous malformations (2), hypertensive intracerebral hemorrhages (2) and ischemic stroke (1). Image quality varied by operator, ultrasound system, and postoperative changes. There were no incision infections or cranioplasty revisions.

Conclusion Transcranial ultrasound through large, customized sonolucent cranioplasty is safe and feasible after decompressive hemicraniectomy. This imaging technique may alleviate the cost, transport, and radiation burden of CT in select ICH patients.

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Abstract P-023 Figure 1

Disclosures C. Rossitto: None. H. Tabani: None. A. Reynolds: None. C. Kellner: 1; C; CPK receives research funding from Longeviti Neuro Solutions, Penumbra, Integra, Viz.AI, Minnetronix, Siemens, and Cerebrotech.