Pediatric Neurosonology in Practice: Bridging Anatomy, Physiology, and Clinical Decision‐Making
Bogdana S. Zoica, Marina Mir, Monica S. Vavilala, John Wright, Ee Tein Tay, Aida Sehic, Brian Appavu, Brittney Johnston, Vidit Bhagarva, Sishir Mannava, Virginie PlanteABSTRACT
Pediatric neurosonology is an important component of non‐invasive brain monitoring. The combination of transcranial and ocular ultrasound enables real‐time assessment of cerebral blood flow velocities, autoregulation, and intracranial dynamics across different clinical settings. This narrative review synthesizes the main themes presented at the Pediatric Neurosonology Symposium , held in August 2025 to celebrate 50 Years of Ultrasound Education at Wake Forest University, reflecting the expanding clinical use of ultrasound in the pediatric brain.
The review integrates anatomical and physiological foundations of pediatric neurosonology with bedside applications across acute, perioperative, and intensive care medicine. Structured into key thematic domains—B‐mode for rapid assessment of skull fractures and intracranial pathology and ocular ultrasound, transcranial Doppler use in hemodynamic assessment, critical illness and extracorporeal life support, and real‐time cerebral autoregulation— the review presents practical insights in this emerging field. Topics include point of care evaluation in head trauma in the emergency department, optic nerve sheath diameter for intracranial pressure assessment, pediatric stroke monitoring, cerebral autoregulation, transcranial Doppler thresholds for vasospasm and perfusion failure, and cerebral circulatory arrest. Real‐world examples illustrate how ultrasound can transform cerebral physiology into actionable, bedside decision‐making, potentially complementing other neuromonitoring modalities.
Broader clinical integration of pediatric neurosonology will require standardized training, multicenter validation studies, and reduced variability in implementation across institutions. With scientific and clinical collaboration, pediatric neurosonology may bridge gaps in understanding of anatomy, physiology, and individualized care, offering a dynamic and repeatable window into the pediatric brain during illness.