Neonatal Neurosonography | Anatomy and Protocol

Summary

This 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

00:00

🧠 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.

05:02

🔍 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.

10:02

🧬 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.

15:04

📐 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.

20:06

👂 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.

25:08

📚 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.

Keywords

💡Neonatology

Neonatology is the medical specialty that focuses on the care of newborn infants, especially those requiring specialized care due to prematurity or medical conditions. In the context of the video, neonatology is crucial as it pertains to the use of neonatal cranial ultrasound for diagnosing intracranial pathologies in preterm and term infants.

💡Intracranial Hemorrhage

Intracranial hemorrhage refers to bleeding within the skull, which can occur in various areas such as the brain tissue, ventricles, or surrounding spaces. The script discusses this as a significant indication for neonatal neurosonography, particularly in preterm infants who are at an increased risk.

💡Sonography

Sonography, also known as ultrasound, is an imaging technique that uses high-frequency sound waves to create images of structures within the body. In the video, sonography is highlighted as an invaluable tool for examining the neonatal brain due to its safety, portability, and ability to provide high-resolution images.

💡Anterior Fontanelle

The anterior fontanelle is a soft spot on the top of a baby's skull that allows for brain growth during infancy. The script mentions the use of small transducers that fit within the anterior fontanelle to perform neonatal cranial ultrasounds, emphasizing its relevance to the procedure.

💡Cerebrum

The cerebrum, also known as the forebrain, is the largest part of the brain involved in higher brain functions such as thought and action. The video script describes the cerebrum's anatomy, its division into lobes, and its importance in neonatal neurosonography for identifying abnormalities.

💡Corpus Callosum

The corpus callosum is a large bundle of nerve fibers that connects the two hemispheres of the cerebrum, facilitating communication between them. The script discusses its role in cognitive functions and its importance as a key sonographic structure in neonatal brain imaging.

💡Ventricles

The ventricles are fluid-filled cavities within the brain that are part of the ventricular system. They contain cerebrospinal fluid and are crucial for the development and function of the brain. The script describes the normal appearance and the potential for hemorrhages within the ventricles in neonates.

💡Germinal Matrix

The germinal matrix is a highly vascularized area of the developing brain found in premature infants. The script explains its vulnerability to bleeding due to delicate capillaries, which is a critical aspect of neonatal neurosonography for early detection of complications.

💡Choroid Plexus

The choroid plexus is a structure within the ventricles that produces cerebrospinal fluid. The script mentions the importance of the choroid plexus in generating images during sonography and its role in the ventricular system.

💡Periventricular Leukomalacia

Periventricular leukomalacia (PVL) is a form of brain damage that affects the white matter of the brain, often in premature infants. The script discusses the importance of monitoring the echogenicity of the periventricular white matter during sonography to detect potential signs of PVL.

💡Sagittal and Coronal Views

Sagittal and coronal views are imaging planes used in sonography to visualize the brain. The script describes these views as standard approaches for obtaining images of the neonatal brain, allowing for the assessment of various structures and potential pathologies.

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