Video caption: Kara Piepenbrink had a long journey to receive a Chiari diagnosis. She had so much imaging done in the journey that brought her to Ryan Lee’s office that she got used to the sound of the MRI machine. (video by Iain Montgomery)
The utility of ultrasound technology — a radiation-free scan that uses sound waves to create a picture of a patient’s anatomy — goes far beyond the traditional associations with pregnancy or mapping vital organs like the heart or lungs.
Vanderbilt Health physicians in the Department of Neurological Surgery’s Hydrocephalus, Chiari and Cerebrospinal Fluid (CSF) Disorders Center are leveraging ultrasound to reduce imaging burden on patients. With the introduction of new technology for imaging at the CSF Disorders Center, patients can receive a point-of-care ultrasound when they visit Ryan Lee, MD, Assistant Professor of Neurological Surgery, at his clinic at the Village at Vanderbilt.
The ultrasound is done on demand and on location — no weekslong scheduling process or secondary visit to an imaging center required — meaning patients get immediate answers from their attending neurosurgeon.
“I knew we were going to have a large volume of patients who needed repeated imaging, and I wanted to make it easier on them by reducing the amount of scans they needed,” said Lee, who serves as Director of the CSF Disorders Center.
Cons of ultrasound turn to pros for patients with CSF disorders
Historically, ultrasound has not been widely used in neurosurgery during the lead-up and follow-up to surgical procedures. Ultrasound waves do not penetrate bone structures well, so getting a clear picture of what is happening underneath the skull in an outpatient clinical setting may present a problem.
However, the unique anatomy of patients with CSF disorders allows a targeted ultrasound test to map the regions of the brain where the skull does not block the waves from penetrating.
“An ultrasound allows us to image the brain from different angles, depending on where we’re looking and where the windows are,” said Lee. “And it can tell us right then and there in a point-of-care fashion if the decompression surgery was effective. It’s really helpful for imaging in the postoperative period.”
These “windows” are very helpful for neurosurgeons to image the brain, particularly with ultrasound, Lee explained. For many patients, a surgical alteration such as a shunt has a secondary benefit of opening up a window that allows ultrasound waves to map the brain, which can be used indefinitely for painless imaging during postoperative check-ins.
Lee also credited the uptake of ultrasound technology for neurosurgical cases to the advent of ultrasound-permeable materials.
“Instead of traditional materials like titanium metal, we have newer ones we can use to reconstruct and reform the surface of the skull that allow ultrasound waves to pass through,” said Lee. “Not only do these materials achieve the goal of stabilizing the skull, but they also allow this new imaging modality.”
Ultrasounds reduce patient burden on multiple fronts
The rapid and radiation-free nature of an ultrasound makes a major difference to patients and their physicians who want to minimize the time burden and safety risks associated with other types of imaging. Between cumulative radiation exposure from repeated CT scans, potential inability to safely undergo an MRI, and the mental burnout a patient can experience while going through prolonged testing, it’s easy to see that everyone benefits from a safe and simple method like ultrasound.
“Much of the benefit of using ultrasound technology in our patient population stems from the huge burden of imaging that these patients require,” Lee said. “And that’s even more exaggerated in patients with hydrocephalus, Chiari malformation and other CSF disorders.”
The burden of pressure is literal, too. Patients with CSF disorders suffer from a variety of symptoms due to their cerebrospinal fluid applying too much pressure to the brain. In receiving treatment for the physical pressure on their brains, patients feel much of the mental pressure dissipate as well.
“It’s more comfortable, and it definitely makes my life easier,” said Kara Piepenbrink, whom Lee treated surgically for Chiari malformation in 2025. “If you’ve had enough tests over the years, those get exhausting. … [Ultrasounds] alleviate stress, and I want to get that done instead.”
Patient’s journey leads her to better imaging methods and a physician who cares
Piepenbrink had a long journey to receive a Chiari diagnosis. She had what felt like countless MRIs in the months leading up to her discovery of Lee’s clinic. She’d even grown used to the sound of the MRI machine.
“I had had every kind of testing done. It was exhausting,” she said.
After receiving nonanswers from specialists elsewhere, Piepenbrink found Lee, who gave her fresh perspective on her disease, explaining how it affected her central nervous system. He made a plan for her to undergo decompression surgery to treat her Chiari malformation.
“I sat down and really thought about it, and I decided, ‘I want to go to the best,’” said Piepenbrink. “Dr. Lee and Vanderbilt made up for all the bad experiences I’d had with other hospitals the year before. … He didn’t look at me as a number; he looked at me as a person.”
Part of the plan for Piepenbrink’s postoperative care now includes check-ins via ultrasound, which she says are far preferable to the battery of testing in MRI and CT machines.
“The ultrasound was painless and fast. Being able to have that versus multiple MRIs is amazing.”
Having an ultrasound machine is all part of the benefit of having a comprehensive center where patients suffering from CSF disorders can have all their needs met in one place, Lee said.
“There’s tremendous value in having a specialty center. We see complex patients who may not fit the textbook symptoms of a certain diagnosis. If a patient has been misdiagnosed, we can right the ship for them.”
