Neonatal Neurosonography | Anatomy and Protocol
Summary
TLDRThis educational video script by Henri Suarez, a pediatric ultrasound expert, offers an in-depth guide to neonatal cranial ultrasound, a crucial tool for detecting intracranial issues in preterm and term infants. Suarez covers the essentials of the procedure, including anatomy, technique, and pathology focus, with an emphasis on intracranial hemorrhages and ischemic events. He highlights the benefits of ultrasound, such as safety, portability, and cost-effectiveness, and provides a detailed exploration of brain structures and standard scanning views, setting the stage for further discussions on related pathologies.
Takeaways
- 🧠 Neonatal cranial ultrasound is a crucial tool for detecting intracranial pathology in both preterm and term infants.
- 👶 The speaker, Henri Suarez, has 10 years of experience in pediatric ultrasound and is registered in abdomen ob/gyn and vascular fields.
- 🔍 High-frequency transducers are used for neonatal ultrasound to provide high-resolution images of the brain's superficial structures.
- 📈 The advancements in ultrasound technology have significantly improved image resolution compared to images from the 1980s.
- 🏥 Indications for neonatal neurosonography include premature birth, distress at birth, neurological changes, cranial dysmorphism, and follow-up for known hemorrhage.
- 🛡️ Ultrasound is beneficial due to its safety, portability, reliability, cost-effectiveness, and ability to produce serial imaging.
- 📚 The brain is divided into the cerebrum, cerebellum, and brainstem, with the cerebrum further divided into four lobes.
- 🔑 Key sonographic structures include the interhemispheric fissure, Sylvian fissure, cavum septum pellucidum, corpus callosum, basal ganglia, and ventricular system.
- 📉 The cavum septum pellucidum is a fetal neurodevelopmental marker that usually fuses by six months of life but can persist in some adults.
- 🧬 The germinal matrix is a highly vascularized structure in premature infants that can be prone to bleeding and is the starting point for intraventricular hemorrhages.
- 📐 Standard views in sonography include anterior fontanelle, coronal, sagittal, and temporal windows, each providing different insights into the brain's anatomy.
Q & A
What is neonatal cranial ultrasound used for?
-Neonatal cranial ultrasound is used worldwide to identify intracranial pathology in both preterm and term infants.
Who is the speaker in the video and what is their background?
-The speaker is Henri Suarez, who has been involved in pediatric ultrasound for about 10 years and is registered in abdomen ob/gyn and vascular.
What are the main objectives of the lecture on neonatal sonography?
-The lecture objectives are to cover anatomy, technique, and pathology, with a focus on intracranial hemorrhages and ischemic events in neonates.
What types of transducers are typically used for neonatal ultrasounds?
-Small transducers with high frequencies, ranging from 4 to 10 megahertz, are used for neonatal ultrasounds to fit within the anterior fontanelle of the neonate and provide high-resolution images.
What are the benefits of using ultrasound for neonatal neurosonography?
-The benefits include safety (no ionizing radiation), portability, reliability of findings, cost-effectiveness compared to MRI and CT scans, and the ability to produce serial imaging for monitoring progression of conditions.
What are the three main sections of the brain?
-The three main sections of the brain are the cerebrum (forebrain), cerebellum (hind brain), and the brainstem.
What is the function of the corpus callosum?
-The corpus callosum is a large bundle of fibers that connects both sides of the brain hemispheres, allowing communication between them and playing a role in eye movement, cognition, and tactile localization.
What is the significance of the germinal matrix in premature infants?
-The germinal matrix is a highly vascularized network of neural cells that can rupture with changes in cerebral vascular perfusion, leading to bleeds in preterm infants and is a critical area to monitor for intracranial hemorrhage.
What is the role of the choroid plexus in the brain?
-The choroid plexus is responsible for producing cerebrospinal fluid, which fills the ventricles of the brain and the spinal cord, and also filters waste from the brain.
What are the standard views used in neonatal sonography?
-The standard views in neonatal sonography include the anterior fontanelle, coronal, and sagittal views, as well as parasagittal and posterior fontanelle views, which allow for comprehensive examination of the brain's anatomy.
What is the significance of the Sylvian fissure in neonatal sonography?
-The Sylvian fissure is a deep groove that separates the frontal and occipital lobes from the temporal loe, and is an important landmark for orientation and ruling out anomalies during neonatal sonography.
Why is the posterior fontanelle view important in neonatal sonography?
-The posterior fontanelle view is important because it allows for a clear view of the occipital horns of the ventricles, which can help in identifying hemorrhages or signs of periventricular leukomalacia or ischemia.
Outlines
🧠 Introduction to Neonatal Neurosonography
This paragraph introduces the topic of neonatal neurosonography, a crucial tool for detecting intracranial pathology in preterm and term infants. Speaker Henri Suarez shares his 10 years of experience in pediatric ultrasound and his qualifications in abdomen ob/gyn and vascular ultrasound. The lecture objectives include covering anatomy, technique, and pathology, with a focus on intracranial hemorrhages and ischemic events. Suarez discusses the use of small, high-frequency transducers for imaging neonatal brains and the significant advancements in imaging resolution since the 1980s. Indications for neonatal neurosonography include premature birth, distress at birth, neurological changes, cranial dismorphism, and follow-up on known hemorrhages. The benefits highlighted are safety, portability, reliability, cost-effectiveness, and the ability to perform serial imaging.
🔍 Key Sonographic Structures in Neonatal Brain Imaging
The paragraph delves into the key sonographic structures essential for neonatal brain scanning, including the interhemispheric fissure, Sylvian fissure, cingulate gyrus, corpus callosum, basal ganglia, ventricular system, and cerebellum. It explains the importance of these structures for ruling out anomalies and as orientation landmarks. Detailed descriptions are provided for each structure, such as the interhemispheric fissure dividing the brain into left and right hemispheres, the Sylvian fissure separating the frontal and occipital lobes from the temporal lobe, and the role of the cavum septum pellucidum as a fetal neurodevelopmental marker. The paragraph also discusses the significance of the corpus callosum in connecting the two hemispheres and the role of the basal ganglia in motor learning and movement.
🧬 Understanding the Ventricular System and Germinal Matrix
This section provides an in-depth look at the ventricular system, a series of fluid-filled chambers in the brain that contain cerebrospinal fluid and the choroid plexus, which produces this fluid. The components of the ventricular system include the lateral ventricles, the third ventricle, and the fourth ventricle, all interconnected through various foramina and aqueducts. The germinal matrix, a highly vascularized network of premature neural cells, is highlighted as a critical structure in premature infants, as it is prone to bleeding due to its delicate capillaries. The development of the cerebrum and the germinal matrix's involution by 36 weeks are also discussed, emphasizing the importance of this structure in the context of preterm infants and intracranial hemorrhage.
📐 Standard Views in Neonatal Sonography
The paragraph outlines the standard scanning views used in neonatal sonography, starting with the anterior fontanelle view, which involves scanning in coronal, sagittal, and left-to-right directions. It describes the visualization of various brain structures, such as the interhemispheric fissure, lateral ventricles, corpus callosum, cingulate gyrus, and the temporal and parietal lobes. The importance of the choroid plexus and its location within the lateral and third ventricles is also highlighted. The paragraph proceeds to describe other views, including the midline sagittal view, parasagittal views focusing on the thalamus and temporal lobe, and the posterior fontanelle view, which is crucial for examining the occipital horns of the ventricles and detecting hemorrhage or ischemia in the paraventricular white matter.
👂 Temporal Window and Mastoid Fontanelle Views
This paragraph discusses additional scanning views in neonatal sonography, specifically the temporal window and mastoid fontanelle views. The temporal window, located above the ear, provides a clear transverse or axial view of the brain, similar to the biparietal diameter used in fetal measurements. It allows for the examination of the lateral ventricles, interhemispheric fissure, midbrain, and cerebellum. The mastoid fontanelle view, posterior to the ear, is highlighted as an excellent view for examining the cerebellum, fourth ventricle, midbrain, and pons. This view is crucial for detecting abnormalities in the cerebellar region, such as increased cerebellar fluid or posterior fossa cysts.
📚 Conclusion and Future Tutorials
The final paragraph concludes the discussion on neonatal neurosonography techniques and anatomy, with a promise of future tutorials covering pathologies like intraventricular and subependymal hemorrhages, hypoxic-ischemic encephalopathy, and congenital anomalies. The speaker, Henri Suarez, thanks the audience for their attention and hopes that the information provided will be useful in their practice of neonatal neurosonography.
Mindmap
Keywords
💡Neonatology
💡Intracranial Hemorrhage
💡Sonography
💡Anterior Fontanelle
💡Cerebrum
💡Corpus Callosum
💡Ventricles
💡Germinal Matrix
💡Choroid Plexus
💡Periventricular Leukomalacia
💡Sagittal and Coronal Views
Highlights
Neonates worldwide benefit from neonatal cranial ultrasound for detecting intracranial pathology in both preterm and term infants.
Henri Suarez, with 10 years of experience in pediatric ultrasound, discusses the importance of neonatal sonography.
The lecture focuses on intracranial hemorrhages and ischemic events, crucial for understanding neonatal brain health.
Small transducers are used for high-resolution imaging, fitting within the neonate's anterior fontanelle.
Advancements in ultrasound technology have significantly improved image resolution compared to the 1980s.
Indications for neonatal neurosonography include prematurity, distress at birth, neurological changes, and cranial abnormalities.
Ultrasound is a safe, portable, and cost-effective imaging method with reliable diagnostic findings.
The brain is divided into the cerebrum, cerebellum, and brainstem, each with distinct functions and structures.
Key sonographic structures include the interhemispheric fissure, Sylvian fissure, and the corpus callosum, essential for orientation and anomaly detection.
The cavum septum pellucidum is a fetal neurodevelopmental marker with clinical significance in CNS abnormalities.
The corpus callosum, the largest white matter structure, is vital for inter-hemispheric communication.
Basal ganglia are critical for motor learning, movement, and motivation, with components like the thalamus and caudate nucleus.
The ventricular system, containing cerebrospinal fluid, includes the lateral, third, and fourth ventricles.
The germinal matrix is a highly vascularized area in premature infants, prone to hemorrhage.
Choroid plexus within the ventricles produces cerebrospinal fluid and filters waste.
Standard views in sonography include the anterior fontanelle, providing six key perspectives for comprehensive brain imaging.
The posterior fontanelle view is crucial for detecting blood in the ventricles and assessing for periventricular leukomalacia.
Upcoming tutorials will cover neonatal neurosonography pathologies, expanding on hemorrhages and ischemic conditions.
Transcripts
hello there ladies and gentlemen today
I'm gonna go over neonatal neural
sonography neonatal cranial ultrasound
is used in Nicky's all over the world
and it's an invaluable tool in finding
intracranial pathology in preterm
neonates and also in term infants so
before we begin here's a little bit
about me my name is Henri Suarez and
I've been involved in pediatric
ultrasound for about 10 years I'm
registered in abdomen ob/gyn and also
vascular so as I said before the lecture
objectives are going to be anatomy the
technique and the pathology though on
this video I'm just going to focus on
intracranial hemorrhages and ischemic
events typically what we do these exams
we use small transducers like this one
from GE or this one from axon they have
a very small footprint and it fits
within the anterior fontanelle of the
neonate with these they're also pretty
high frequencies they go from all the
way down from four all the way down from
four to about ten megahertz on very
small babies we can use a linear you get
extremely high resolution images we can
also see the superficial structures like
the superior sagittal sinus superior
cortical regions of the brain you use it
on larger babies to
they're fonteneau's is open enough and
you get some pretty exquisite images
with these probes this is a picture from
the 1980s
you can see
is not there's not a whole lot of
resolution in this image you can kind of
make out you know some of the structures
like the Sylvian fissure is here the
ventricles
you know the cranial bone and you know
this is a modern image and the the
resolution is just amazing so what are
the indications for neonatal neuro
sonography uh the most common reason
you're going to do a four is a premature
infant babies born before 32 weeks
gestational age and weighing less than
1500 grams are at an increased risk for
intracranial hemorrhage babies born in
distress or with low Apgar scores any
neurological changes after the baby's
born warrants neonatal ultrasound
cranial dismorphism like microcephaly or
cranial synostosis and also for
follow-up for a known hemorrhage to see
if it progresses the benefits of
ultrasound is number one and safe
there's no it's non ionizing radiation
the portability you can use the the
ultrasound machines in the NICU which
benefits the babies as they're very
unstable and transferring them down to
CT or MRI is sometimes not possible so
we can bring the machine to the bedside
and provide high quality imaging right
there
the findings are typically reliable you
know you can diagnose a lot of different
pathologies with ultrasound it's
relatively inexpensive especially when
you compare it to MRI in cat scan and
you could also produce serial imaging
you can scan the babies every day if you
need to to see progression of hemorrhage
or to even see the maturation of the the
neonatal brain tissue so let's begin
with the anatomy the brain is divided
into three main sections the cerebrum or
forebrain which is this section right
here it's the most valid portion the
cerebellum also known as the hind brain
and the brain stem so below the
cerebellum all the way down and to the
spinal canal is the brainstem um the
brain has many convolutions known as
gyri and sulci as you see right here and
there are four OHS and ridges and this
allows the brain to have increased
surface area so we can have more brain
tissue within the size of a human skull
so to begin with the cerebrum is divided
into four sections you have the frontal
lobe which is this yellow section right
here which is divided by the central
sulcus the parietal lobe the temporal
lobe which is divided by the Sylvian
fissure and the occipital lobe which is
the posterior portion so this is front
obviously frontal this is posterior
occipital parietal and temporal and over
here again you have the cerebellum the
cerebrum is also divided into two
hemispheres a right and a left so here
is a posterior view of a sheep brain and
you see the left hemisphere the right
hemisphere and the cerebellum and then
the brainstem and spinal cord
these hemispheres are are connected by
the corpus callosum which you can see
right here and here's just a drawing of
the hemispheres this is from the
front aspect so this would be right and
this would be left and the corpus
callosum would be around here so key
sonographic structures these are
structures you're going to see while
you're scanning almost always and
they're very important to rule out
anomalies and for orientation to
landmarks you have the inter hemispheres
fissure which is a large midline groove
the Sylvian fissure 'z which I showed
you before the caving septum pellucidum
the corpus callosum the basal ganglia
which is gray matter structures at the
base of the brain which contain thalamus
and caudate nucleus to name a couple of
them the ventricular system and the
cerebellum so the in term hemisphere
fissure is a deep groove that divides
the brain into left and right
hemispheres here's a sonographic image
and this red line is showing the groove
or the fissure and then you have your
right and your left cerebral lobes or
hemispheres here's an anatomical drawing
also showing the intermix for your
fissure and within the hint
interhemispheric fissure you have the
falx cerebri which is a an invagination
of the dura mater that goes down into
that groove so the dura mater is
covering the brain part of the meninges
and here you can see an anatomical
section showing the fox cerebri and this
all this is the dura mater here's
another image of the fox
right right here is an anatomical
drawing in red so this goes all the way
down and then here you have the
tentorium which separates the cerebrum
to the cerebellum
so the Sylvian fissure x' is a deep
groove but it's horizontal whereas the
inter hemisphere fissure is a
longitudinal midline fissure this one's
a horizontal one and it's bilateral
here in red you can see it on the gross
anatomy section and here in the
sonographic image on sonography if you
look at it they kind of look like
sideways wise that's the way I've always
seen them and they separate the the
frontal and the occipital lobes from the
temporal lobe superiorly it is also
known as the lateral sulcus and deep to
it you have the insula so the Cavin
septum pellucidum is a midline
fluid-filled structure it's located
between the bilateral anterior horns of
the ventricle system um it is a fetal
neurodevelopmental marker it is one of
structures we routinely interrogate
during obstetrical examination usually
at 18 weeks for the fetus
its absence is associated with several
central nervous system abnormalities a
couple of them is corpus callosum a
Genesis and septal optic dysplasia and
this structure usually fuses by six
months of life though it persists in 15%
of adults so you can do an adult uh an
MRI and an adult 40 year-old adult and
you might be able to see the Cavin
septum pellucidum in them here's a
couple images sonographic and gross
anatomy so right here the asterisk is
that's the cave um septum pellucidum
right here and here it is between the
two lateral ventricles so these are the
anterior horns or the lateral ventricles
and right in between them is the cave
them septum pellucidum and you can see
this image is a sonographic image of
this area here so lateral ventricles and
here's a diagram showing the ventricular
system and then deep to it the KVM
septum pellucidum so this is the cave
and septum pellucidum here
an extension of that is the key from
Virgie which is present in some babies
it goes all the way down to the to the
end of the of the corpus callosum and on
some babies you also have what's called
the cave of Elementor positon I'll go
with that in a second so the cave in
virgi is present in 30% of infants and
it is present in less than 1% of adults
so here you go you got the corpus
callosum right there KVM septum
pellucidum and then the cave in virgi
the cave envelopment upon settlement
would be located in this region right
here Antero inferior to the spleen ium
of the corpus callosum so here are
images of the cave and vellum inter
positive as I showed you earlier
corpus callosum Cavin vellum inter
processing on this baby you can see the
CSP or the cabin burglary are not even
present they've already been obliterated
so on these structures it's good to
place Doppler to rule out vein of gallon
aneurysm or any other type of venous
aneurysm and the cave envelopment
opossum is not associated with any
congenital abnormalities all right the
corpus callosum is a very important
structure it's a very large bundle of
fibers that connects both sides of the
hemispheres as you can see the fibers
crossing over right here so this is one
hemisphere right left and then the
corpus callosum crossing over so all
these are nerve fibers nerve fibers and
then they cross over and they allow
communication between the two
hemispheres it is the largest white
matter structure and it contains about
200 million axons the components of the
corpus callosum are the rostrum or
anterior inferior part the genu which is
also anterior the body and then the
selenium it is important in eye movement
cognition and tactile localization so
wherever you're able to feel structures
and how they relate to you in 3d space
and they have been reportedly larger and
females in some studies perhaps that's
why women's brains talk better to each
other who knows so here's a sonographic
coronal image of the corpus callosum
right here you see
the white matter tracks going out into
hemispheric fissure corpus callosum CSP
the lateral ventricles here's a sagittal
image and then a gross anatomy anatomy
image showing the same section so here's
a rostrum anterior inferior to the genu
which is this portion here and then this
is the body of the corpus callosum some
also term this the truncus and here you
have the spleen ium so here again
rostrum genu body and spleen iam and
then you know right below you have the
CSP a little bit of cave in verga here
all right so the the basal ganglia is a
collection of gray matter structures at
the base of the brain as I said earlier
it is very important in motor learning
I've movement and motivation the
components a few of the components at
least are the thalamus the caudate
nucleus the Globus pallidus and the
poolman within the caudate nucleus and
the thalamus we have a section called
the caudal filament goof which is very
important for sonography so here you go
you get the head of the caudate nucleus
here the thalamus
here's your echogenic Cory plexus and
then this section here is called the
caudal thalamus groove so if you see any
echogenicity x' here of the same or more
to the choroid plexus
that's a hemorrhage alright the
ventricular system is a series of fluid
filled chambers in the brain that
contains cerebrospinal fluid they also
contain the choroid plexus which
produces that fluid and some of the
components are the lateral ventricles
which you have a right and left one the
third ventricle which is beneath the
right and left lateral ventricles and
the fourth ventricle which is beneath
the third ventricle the lateral
ventricles are connected to each other
or connect to the third ventricle via
the foramen of Monro the third and
fourth ventricle are connected via the
cerebral aqueduct or the aqueduct of
and in very young fetuses the
ventricular system has germinal matrix
all around it which is a very important
structure which I'll get to in a second
so here's a 3d rendering by ultrasound
of the ventricular system so this is a
fetus they take a coronal view a
sagittal view and a transverse view and
here's the 3d rendering of it so here's
your lateral ventricles here's your
third ventricle foramen of Monro and
same thing here in lateral ventricles
here we have a sagittal view of the
lateral ventricle you have the anterior
horn the body the occipital horn and the
temporal horn within the lateral
ventricle you have the choroid plexus
and the anechoic cerebral spinal fluid
here's a coronal view again the lateral
ventricles see SP here in the middle
foramen of Monro and then the third
ventricle and here is an anatomical
illustration of the ventricular system
the third ventricle located right
between below the lateral ventricles and
as I said right now connected by the
foramen of Monro this structure right
here here you have some Corre plexus at
the roof of the third ventricle filled
with cerebral spinal fluid on a lot of
babies you will not see such a clear
view of the third ventricle because it's
a lot smaller right here in the center
this echo genic structure is known as
the masa intermedia connects to both
sides of the thalamus the third
ventricle is connected to the fourth
ventricle via the aqueduct of Sylvius
also known as a cerebral aqueduct once
it passes through this duct it goes into
this triangular
structure right here which is the fourth
ventricle here you see the triangular
shape structure right there the germinal
matrix very important structure present
in premature premature infants it's also
it's a fetal structure it in volutes by
36 weeks it is very important because
this is where the bleeds and preterm
infants begin the germinal matrix has is
a highly vascularized network of
premature neural cells that become glial
cells the capillaries are very delicate
and can rupture with any change in fetal
cerebral vascular perfusion so it's very
delicate rapid change in high blood
pressure and these are tiny capillaries
can rupture and then the blood starts to
accumulate and the cutoff allama groove
once it breaks through that ventricular
lining or ependymal lining it goes into
the ventricle it becomes an
intraventricular hemorrhage here is a
nice illustration of the development of
the cerebrum the germinal matrix and the
ventricles so here is from seven weeks
to 28 weeks you can see that baby's
brain is very smooth the fetal brain
very smooth
by 2000 weeks you are you start to see
some gyri and the germinal matrix as you
see is present around all of the
ventricular system a lot of tissue as
the baby's brain starts to develop you
get bigger the germinal matrix begins to
involute as most of the cerebral tissues
has been built and by the time the baby
is born
most of the brain is already but
premature is already bum is already
developed and here you can see the
ventricular system very early on maybe
brains are almost completely ventricles
then as the cerebral tissue keeps on
building and building and developing the
ventricles all the same size up here a
lot smaller in comparison to the brain
Corie plexus very important structure is
located within the lateral ventricles it
is made up of a network of epithelial
cells capillaries and connective tissue
this tissue is located in the lateral
ventricles it is also located in the
third ventricle and a little bit in the
fourth ventricle though we typically on
ultrasound
only see them in the lateral ventricles
and a little bit and the roof of the
third ventricle this tissue creates the
cerebral spinal fluid that's within the
ventricular system in the spinal cord
and it also is known to waste filter
wastes all right so the standard views
on stenography the most frequent one
being the anterior fontanelle so you
place your transducer right here and a
soft spot of the baby's cranium and you
scan sweeping anterior to posterior and
coronal views and left-to-right and
sagittal views so here your six standard
views for coronal
see them right here sweeping from
anterior to posterior
image is all the way anterior and you
see the interventricular I mean the
inter hemispheric fissure
you got your bilateral frontal lobes
with the white matter
here's your gross anatomy depiction of
the same area and then you also see the
orbits on very premature babies you can
see the outline of the eyes you get also
sometimes if you angle anterior enough
see even the lens of the eyeball which
is very cool to see all right so the
second view a little bit more posterior
you got your your CSP lateral ventricles
their adventure go here you see CSP
lateral ventricles very slit-like which
is normal and you can see the third
ventricles this picture might be a
little bit too interior or the third
ventricle is so slit like you can't see
it and then you have your Sylvian
fissures what I like to call the
sideways wise all right third image a
little bit more posterior you have your
corpus callosum very important structure
corpus callosum here you have your
cingulate gyrus
you have Cory plexus and the lateral
ventricles and here's Cory plexus in the
roof of the third ventricle and this
image right here that's the Corey plexus
very tiny hard to see but if you were to
zoom this image up you'd be able to see
them a little better third ventricle
third ventricle sylveon fissures right
here these and then your temporal lobes
temporal lobes right there alright so
fourth image a little bit more posterior
you have your corpus callosum which is
already beginning to be the posterior
part known as the spleen iam you can
still see some of the Sylvian fissure
you have your tint aureum which 10th
Tour iam you just think tent tent is
triangular or at least you know some of
the camping tents I've seen are
triangular and then you are your
cerebellar hemispheres cerebellar vermis
which is the midline and then the
cisterna magna alright so fifth image is
through the level of the quarry plexus
also the this part of the quarry plexus
is the largest part is also known as the
Glomus it's located within the lateral
ventricles here you can see an
anatomical depiction of it very lumpy
looking like tissue and then you have
your periventricular white matter which
is very important a key to notice is
that the per ventricular white matter is
echogenic but it shouldn't be more
echogenic than the Corre plexus if
that's the case then you have to wonder
if there's any ischemia and worry about
periventricular leukomalacia and then
the last image posteriorly is of the
parietal lobes and the white matter
Interbrew interhemispheric fissure you
can see the cranial bone very clearly
here so your sagittal view is begin with
your first one as this midline second
one through the level of the cattle
thalamic groove which is right here and
then your lateral ones which are of the
periventricular white matter and the and
the lateral sulcus or Sylvian fissure so
here's your midline view
so here's your mid lane view you have
your CSP cave themself and pellucidum
and this baby you have cave over key
here you can only see you can't see the
cave there's no cave and Fergie this is
an adult brain you have your corpus
callosum genu body spleen iam third
ventricle with the Meza intermedia
cerebral aqueduct and fourth ventricle
here you can see the fourth ventricle
triangular shape very clearly
alright parasagittal you have you're the
head of the caudate nucleus the thalamus
here you see the caudate nucleus very
clearly and some of the thalamus and
then here's your cow tooth ulema groove
very important any I get echogenic lump
here a centimeter or more or typically
about a centimeter is blood the quarry
plexus usually begins about one third
after the the beginning of the thalamus
so any echogenic lump here is considered
a germinal matrix hemorrhage and then
you have your temporal lobe cerebellum
more PI recessional
you have still some cutting nucleus here
thalamus very important view of the
corey plexus here
going into the temporal lobe and into
the temporal horn um as I said before
the periventricular white matter should
not be more echogenic than the corey
plexus so that's good and then you have
your temporal lobe
a little bit of cerebellum here there's
more in this image and then all the way
parasagittal you have your
periventricular white matter you can see
the white matter of the brain the
Sylvian fissure and then the temporal
lobe all right another view is the
posterior fontanelle this is very
important because within the posterior
fontanelle you just angle backwards
towards the back of the skull and you'll
be able to see the occipital horns on
the ventricles very clearly so the way
the baby with their head laying down the
most dependent port portion of the
ventricular system is the occipital
horns so if you're concerned that there
may be blood in the ventricle but you're
not sure you can use this view to see if
there's any calculation of echogenic
material here which would be hemorrhage
you can see the Glomus of the Corre
plexus another reason to look at this
region is if you're concerned for
periventricular leukomalacia or ischemia
of the paraventricular white matter you
can see it here and you can see that is
not more iconic than the Corre plexus
all right another scanning view is the
temporal window this is right above the
ear right here in this notch where the
ear meets the temporal part of the skull
and you can see a very clear transverse
or axial view of the brain very
reminiscent of the biparietal diameter
that we do for fetuses here's a little
bit more superior you can see the cable
septum pellucidum and the lateral
ventricles interhemispheric fissure some
of the midbrain right here and then when
you angle a little bit more all you see
is the bilateral
hemispheres the sylveon sylveon fissures
cerebellum you'll be able to see if
there's any increased cerebellar fluid
or um a genesis of the vermis any type
of posterior fossa cyst
the last view would be the mastoid or
fontanel so you go posterior to the ear
and it's a very very good view for the
cerebellum here you have the cerebellar
hemispheres cerebellar hemispheres you
have your fourth ventricle fourth
ventricle right here and depending if
you're a little high you'll be a
midbrain if you angle it a little low
you'll be out of the pons and then you
got the cerebellar vermis right there
alright so in another video I'll go over
the pathologies you know mainly the
intraventricular and sub ependymal
hemorrhages I will also go over um um
hypoxic ischemic encephalopathy I'll go
over congenital anomalies as well well
there you have it we went over the
technique we wanna over some very
important anatomy I'm going to be doing
other tutorials in the future I hope you
enjoyed this and I hope you've used some
of this information and your practice of
neonatal neuro sonography thank you
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