Background and ObjectivesComputerized tomography (CT) is a cornerstone of the identification and management of acute changes in neurosurgery patients. In addition to the monetary expense of CT scans, further costs are incurred due to the time of patient transport and radiation exposure. Ultrasounds (US) offer a safe, inexpensive, and bedside alternative to CT but obstacles remain due to decreased penetrance in the adult skull. Sonolucent Cranial Implants (SCI) offer a window for ultrasounds to view intracranial architectures. MethodsThe authors performed a PRISMA guidelines-based systematic review of the literature. Information was extracted from included articles in regards to illness pathology, ultrasound imaging feasibility, comparison to standard imaging, infections, and revisions. Costs were collected in regards to price of implant and follow-up imaging. Results226 articles resulted of which 5 were included in the study. Ninety non-duplicate patients who received SCIs were analyzed. The pathologies of included patients is as follows: 51 patients were after extracranial-intracranial bypass, 37 after VP shunt placement for hydrocephalus, one after tumor resection, and one after cranioplasty following decompressive hemicraniectomy. All studies noted feasibility of ultrasound and comparability to standard imaging following SCI placement. Follow up imaging with trans-sonolucent cranial implant ultrasound was estimated to save up to $4,000 per patient depending on the procedure. ConclusionInitial studies suggest that ultrasound imaging through SCIs is a safe and efficacious alternative to CT imaging in neurosurgical patients. Cost analysis suggests that SCI and subsequent US can offer a cost savings compared to current treatment.