Ultrasound-guided needle technique as a relaxation strategy for early cranioplasty: illustrative case.

BACKGROUND: Achieving brain relaxation during early cranioplasty is essential for safe dural closure and bone flap replacement. Conventional strategies, such as preoperative lumbar drainage or intraoperative external ventricular drain (EVD) placement, are effective but carry significant procedural burden, increased costs, and risks associated with indwelling hardware. The authors describe a simplified, ultrasound-guided needle technique as a resource-sparing alternative. OBSERVATIONS: During cranioplasty in a patient with a tense operative field, intraoperative ultrasound was utilized to visualize the temporal bone window. A sterile 18-gauge angiocatheter was introduced under real-time guidance, adhering to validated anatomical safety limits. Aspiration of 35 mL of CSF yielded immediate brain relaxation, facilitating tension-free dural closure. No intraoperative complications occurred. A literature review distinguished this approach from existing methods, identifying it as the first report of a transient, catheter-free aspiration for this indication, effectively eliminating the need for tunneling or postoperative drain management. LESSONS: Ultrasound-guided transient ventriculocentesis of the temporal horn offers a safe, cost-effective, and rapid alternative to formal EVD placement. This technique combines the precision of image guidance with the simplicity of a single-puncture aspiration, successfully achieving operative goals while avoiding the morbidity and resource utilization of long-term drainage systems. https://thejns.org/doi/10.3171/CASE26132.