This document discusses fetal neurosonography and the sonographic appearance of fetal brain structures throughout gestation. It begins with an overview of embryonic brain development and the division of the brain into sections. It then examines how the appearance of specific structures changes with gestational age, including the posterior fossa, lateral ventricles, and cerebellum. Serial images demonstrate the maturation and relationships between structures over time. The role of 3D imaging in examining the posterior fossa is also mentioned.

1. Fetal
Nuerosonogram
Professor Hassan Nasrat FRCS, FRCOG
The Fetal Medicine Clinic
The First Clinic
JUCOG January 2013
Sunday, July 28, 13

2. 
Microcephaly
Holoprosencephaly
Head normal or small

Chiari
Malforma3on
ACC

Dia


Anencephaly
Occipital Encephalocele
Schizencephaly
Schizencephaly
Circle of Willis Mallformation
Vascular
Malforma3ons
SOP
Pilu
Imaging Findings
 Herniated brain tissue
 „cyst within the cyst“
 Ventriculomegaly 7080%
 Microcephaly 25%
 Polyhydramnios
 Oligohydramnios

Encephalocele
PF-­‐Fluid-­‐Cyst
CAVE:
 Associated with multiple
syndroms ( Meckel- Gruber )
Hydrance
halus , T 21
Ventriculomegaly
Hemimegalencephaly
Arachnoid
cyst
Hydranecphaly
Yong seok et a
2
Sunday, July 28, 13

3. Congenital
CNS
Anomalies
o Incidence
in
longtem
studies
about
1
%
o
Only
minimal
identified
at
birth
o
Screening
Increases
The
Number
Of
Referred
Cases
For
Evaluation
Of
Suspected
CNS
Anomalies.
o The
CNS
sonographic
appearance
changes
throughout
pregnancy
Sunday, July 28, 13

4. Learning
Objec3ves
✤ Embryonic
development
of
the
CNS
in
relation
to
sonographic
findings
✤ Standard
Sonographic
Examination
of
the
CNS
✤ Fetal
Neurosonography
and
the
Role
of
3
D
(systemic
approach
to
examination
of
the
Posterior
Fossa)
4
Sunday, July 28, 13

5. Embryology of the
CNS
Sunday, July 28, 13

6. At
5th
Week
The
Cells
Destined
To
Form
The
Notochord
Infiltrate
Into
The
Embryonic
Disc.
I t
I n d u c e s
T h e
Overlying
Embryonic
Tissue
To
Thicken
And
Ultimately
Fold
Over
And
Fuse
As
The
The
Fusion
Starts
In
Neural
Tube.
The
Midtrunk
Of
The
E m b r y o
A n d
Subsequently
Extends
To
The
Cranial
And
Caudal
Ends
Neural
Crest
Neural
Groove
Neural
Plate
Sunday, July 28, 13
Ectoderm
Neural
Tube

7. Prosencephalon
Mesencephalon
Rhombencephalon
7
Sunday, July 28, 13

8. Three orthogonal images and thick slice of three-dimensional reconstructed image (lower right) of normal brain at
8
the end of 8 weeks of gestation. The development of premature ventricular system is seen.
Sunday, July 28, 13

9. Prosencephalon
Mesencephalon
Three orthogonal images and thick slice of three-dimensional reconstructed image (lower right) of normal brain at
8
the end of 8 weeks of gestation. The development of premature ventricular system is seen.
Sunday, July 28, 13

10. Normal brain development on the mid-sagittal section between 8 and 12 weeks of gestation). Note the remarkable changing of premature brain
9
appearance.
Sunday, July 28, 13

11. AJR:166,
AJR:166,
Changing
Ultrasound
appearance
of
the
The
Posterior
Fossa
throughout
gesta3on
SONOGRAPHIC
February 1996
February 1996
AJR:166,
February 1996
ANATOMY
SONOGRAPHIC
ANATOMY
SONOGRAPHIC
OF DEVELOPING
433
CEREBELLUM
OF DEVELOPING
CEREBELLUM
ANATOMY
OF DEVELOPING
CEREBELLUM
433
433
10
C
Sunday,
C
Fig.
C C July 28, 13
D
13.-Drawings
depicting
some
relevant
features
D
DD
of fetal cerebellar
development.

12. The vermis develops superiorly to inferiorly.
Hypoplasia or developmental arrest results in
varying size deficits of the inferior portion, leaving
a relatively square defect that communicates with
the fourth ventricle and separates the lower
cerebellar hemispheres.
11
Sunday, July 28, 13

13. C
D
Fig. 13.-Drawings
depicting
some relevant features
of fetal cerebellar
development.
A, Axial drawing
of developing
cerebellum
at 5 weeks’ gestational
age shows that developing cerebellar hemispheres have not yet grown
toward midline and thatfourth
ventricle is covered only byfourth ventricular roof,which
is onlytwo
cell layers thickatthis
stage of development.
B, Sagittal drawing of developing cerebellum at 10 weeks’ gestational age shows small cerebellum located rostrally over fourth ventricle,
with caudal fourth ventricle being covered only by thin fourth ventricular roof.
C, Sagittal
drawing at 16 weeks’ gestational age shows further caudal growth of cerebellum
ening
0,
of caudal
Sagfttal
fourth
drawing
ventricular
roof.
at 17 weeks’ gestational
age shows
cerebellum
We have shown that the sonognaphic
appearance
of normal cemebellar
development
can resemble
pathology
early in
the second
trimester.
Our findings
indicate
that the mature
relationships
of the posterior
fossa structures
are not established until at least 18 weeks’ gestational
age; therefore,
the
Sunday, July 28, 13 diagnosis
prenatal
sonographic
of Dandy-Walker
complex
and vermis
covering
4. Achinon
entire
R, Tadmor
ten of pregnancy:
and vermis over fourth
fourth
0. Screening
tnansvaginal
ventrIcle,
teno
thic
and
with thick-
ventricle.
for fetal anomalies
versus transabdominal
1991 1:186-191
during
the first tnimesUltra-
sonography.
sound Obstet Gynecol
5. Nicolaides
KH, Azan G, Byrne D, Mansur C, Marks K. Fetal nuchal translucency: ultrasound screening for chromosomal
defects in first trimester of
pregnancy.
BMJ 1992:304:867-869
6. Bronshtein
M, Blumenfeld
I, Kohn J, Blumenfeld Z. Detection ofcleft lip by early
12

14. of posteriorB, Next caudal image identifies fetus.
fossa in 13- to 14-week-old
called
in stea
fourth ventricular roof joining cerebellar hemispheres acquisition Vermis
fetus.
A, Vermis isand separating
identified
between
cerebellar
hemispheres
rostrally
(arrow).
age of posteriorfossacaudally
in
(arrow)
fourth ventricle
and cisterna
magna.
but not
B, Next caudal image identifies fourth ventricular roof joining cerebellar hemispheres
fetus. Vermis is identified
(arrow) and separating
fourth ventricle
and cisterna
magna.
but not caudally at this s
Effect
of
Gesta=onal
age
(Posterior
Fossa)
Fig. 7.-Axial
Fig. 7.-A
and
tenor fossa
tenor fossa in 16-weekA and
A and B, Caudally,
thickto enoug
thick enough
be v
and sagittal and sagittal
(B) planes
axial
sagittal
sonograms of posterior fossa in 16-week-old fetus
fourth ventricular roof is visualized in both planes (arrow)
13
Sunday, July 28, 13

15. gure 1 Transvaginal scan of a 14-week fetus. (a) Oblique-1 (sagittal) section: the fetus is facing left. The choroid plexus fills the antrum
ure 1 Transvaginal The of aa14-week appear Oblique-1 but are normal; (b)the fetus facing left. The choroid plexus fills the antrum
Transvaginal scan of 14-week fetus. (a) Oblique-1 (sagittal) section: a Frontal-2 (coronal) The choroid plexus fills the horns
ure 1lateral ventricle. scan anterior hornsfetus. (a)prominent, (sagittal) section: the fetus isis facing left. section through the anterior antrum
the
thelateral ventricle. The anterior horns appear normal for this are normal;age; ahowever, this same sonographic picture at anterior horn
he lateral ventricle. The anterior horns appear prominent, but are normal; (b) a Frontal-2 (coronal) section through the 20 weeks or
the lateral ventricles. The anterior horns are prominent, but gestational (b) Frontal-2 (coronal) section through the anterior horns
the is consistent with ventriculomegaly or hydrocephalus this gestational age; however, this same sonographic picture 20 weeks or
he lateral ventricles. The anterior horns are normal for
ore lateral ventricles. The anterior horns are normal for this gestational age; however, this same sonographic picture atat 20 weeks o
re is consistent with ventriculomegaly or hydrocephalus
re is consistent with ventriculomegaly or hydrocephalus
Effect
Of
Scanning
Level
(Posterior
Fossa)
Higher Still
gure 2Lower-most Section (horizontal) views through the posterior fossa. (a) This is the lower-most section (see insert). The
Three serial, almost axial
Somewhat Higher
ure
ermis2 Three serial, almost axial (horizontal) views through fourth ventriclefossa. (a) a widethe this gestational age, normal) median
gure2 appears to be open (arrow) and communicates with the the posterior fossa. (a) This isis (at lower-most section (see insert). The
Three serial, almost axial (horizontal) views through the posterior through This the lower-most section (see insert). Th
mis appears to be open (arrow)and communicates with rightfourth ventricle the cerebellar (at this gestational age, normal) median
perture (foramenbeopen (arrow) (b) somewhat higher,withthe fourth left sides ofthrough a widehemispheres appear closer to eachmedia
rmis appears to of Magendie); and communicates the the and ventricle through a wide (at this gestational age, normal) other
rture (foramen of Magendie); (b) somewhat higher,
rrow); (foramenof Magendie); (b) defect’ is seen and theright and left sides appears as a discrete No ‘vermiancloser to each othe
(c) higher still, Appears To
entity. C, appear
ertureThe Vermisno ‘vermian somewhat higher, the fourth and left sides of the cerebellar hemispherescerebellum Defect’other
right ventricle (4) of the cerebellar hemispheres appear closer to each
Thethefourth ventricle (4) appears asas a discrete entity. C, cerebellum
Right And Left Sides a discrete entity. C, cerebellum
row); (c) higher still, no ‘vermian defect’ is seen and the fourth ventricle (4) appears
row); (c) higher still, (arrow) And is seen and
Be Open no ‘vermian defect’
Is Seen And The
Of
The
Cerebellar
Communicates With The
eduncular cistern (cisterna magna) and theHemispheres its closest anatomic structures, namely the cavum septi
fourth ventriFourth Ventricle (4)
Appear
its closestand the pericallosal artery, follow acavum septi
anatomic structures, namely the well-known
duncular ucistern(cisterna magna) land week,fourthventricistern (cisterna n t r i c e the fourth‘normal’
pellucidi anatomic structures, namely As cavum sep
e. Later, r t h
its closest
the
duncularafter the 16th postmenstrual the this ventriFo
Ve magna) and Closer
Appears
A
pellucidi and the pericallosal artery, reach a developmenLater, after the 16th postmenstrualand developmentTo Each Other thepericallosal artery, follow a a well-know
week, this ‘normal’
developmental timetable. They do not follow well-known
pen space narrows as postmenstrual week, this ‘normal’
of
pellucidi and
. Later, after the 16th the growth
Through A giving
en vermis narrows Wide growth and development of
(arrow);
tal stage that allows for Discrete reach a developmene space narrows as the rise to and development of developmental timetable. They do notEntity. a developmen
developmental timetable. sonographic imaging until postThey do not reach
en space progress,as the growth the median aperture
oramen progress, giving rise to the median aperture
e vermis of Magendie) (Figureto the median aperture
vermis progress, giving rise 2). Again, this normal
ramen of Magendie) be interpretedAgain, this normal
onographic finding may (Figure 2). Again, this normal
ramen of Magendie) (Figure 2). by those unfamiliar
Sunday, finding may
nographic July 28, 13 be interpreted by those unfamiliar
tal stage that allows for To search for their presence before
14
menstrual that allows forsonographic imaging until posttal stage weeks 18–19. sonographic imaging until pos
menstrual weeks 18–19. To search for their presence before
they reach weeks 18–19. To search fordevelopment would
menstrual this critical stage in their their presence befor
they reach this critical stage in their development would

16. Effect
of
Gesta=onal
age
(Lateral
Ventricles)
15
Sunday, July 28, 13

17. The fetal cerebellum
Pitfalls in diagnosis
Hypoplasia Or Dysplasia Should Not Be
Diagnosed Prior To 18 Weeks, Before Vermian
Development Is Complete.
An Abnormally Steep Scanning Angle May
Mimic A Prominent Cleft Between The
Lower
Portions
Of
The
Cerebellar
Hemispheres.
16
Sunday, July 28, 13

18. Conclusion
•TheCNS
displays
remarkable
embryological
and
developmental
changes
throughout
gestation.
•Standard
Approach
of
examination
and
evaluation
of
the
CNS
Should
Be
Followed
17
Sunday, July 28, 13

19. Standard Sonographic
Examination of the
FEtal CNS
18
Sunday, July 28, 13

20. Sunday, July 28, 13

21. Sonography
of
the
CNS
Basic
Examination “Neurosongram”
Sunday, July 28, 13

22. Planes
of
Basic
Examina3on
Axial
Planes
Sunday, July 28, 13
Sagibal
Planes

23. Axial
Planes
Sunday, July 28, 13

24. Axial
Planes
a:
Transventricular
Sunday, July 28, 13

25. Axial
Planes
a:
Transventricular
b:
Transthalamic
Sunday, July 28, 13

26. Axial
Planes
a:
Transventricular
b:
Transthalamic
C:
Transcerebeller
Sunday, July 28, 13

27. The
Transventricular
plane
Sunday, July 28, 13

28. The
Transventricular
plane
Frontal
hones
Sunday, July 28, 13

29. The
Transventricular
plane
Frontal
hones
Atrium
Sunday, July 28, 13

30. The
Transventricular
plane
Frontal
hones
Atrium
Sunday, July 28, 13
Choroid
Plexus

31. The
Transventricular
plane
Cavum
Sep3
Pellucidi
Frontal
hones
Atrium
Sunday, July 28, 13
Choroid
Plexus

32. The
Transthalamic
Plane
Sunday, July 28, 13

33. The
Transthalamic
Plane
Thalami
Sunday, July 28, 13

34. The
Transthalamic
Plane
Thalami
Hyppocamas
Gyrus
Sunday, July 28, 13

35. The
Transcerebeller
plane
T
T
Sunday, July 28, 13

36. The
Transcerebeller
plane
T
T
Cavum
Sep3
Pellucidi
Sunday, July 28, 13

37. The
Transcerebeller
plane
Frontal
hones
T
T
Cavum
Sep3
Pellucidi
Sunday, July 28, 13

38. The
Transcerebeller
plane
Cerebellum
Frontal
hones
T
T
Cavum
Sep3
Pellucidi
Sunday, July 28, 13

39. The
Transcerebeller
plane
Cerebellar
vermis
Cerebellum
Frontal
hones
T
T
Cavum
Sep3
Pellucidi
Sunday, July 28, 13

40. The
Transcerebeller
plane
Cerebellar
vermis
Cerebellum
Frontal
hones
T
T
Cavum
Sep3
Pellucidi
Sunday, July 28, 13
Cistrerna
Magna
2-­‐10
mm

41. Sagibal
Planes
Sunday, July 28, 13

42. Sagibal
Planes
A:
The
Midsagittal
Plan
Sunday, July 28, 13

43. Sagibal
Planes
b:
Parasgittal
plane
A:
The
Midsagittal
Plan
Sunday, July 28, 13

44. Mid
SagiGal
Plane
Corpus
Callosum
Cavum
Sep3
Pellucidi
Cerebellum
4th
V
27
Sunday, July 28, 13

45. Mid
SagiGal
Plane
27
Sunday, July 28, 13

46. The
Corpus
Callosum
28
Sunday, July 28, 13

47. The
Corpus
Callosum
Lateral
Ventricles
Splenium
Corpus
Callosum
Thalamus
hypothalamus
Third
Ventricle
Pituitary
Fourth
ventricle
midbrain
28
Sunday, July 28, 13

48. Para-­‐SagiGal
Plane
29
Sunday, July 28, 13

49. Basic Examniation Checklist
Head + Neck
Midline & Falx
Cavum septi pellucidi
Lateral cerebral ventricls
Choroid Plexus
Cerebellum
Cisterna magna
30
Sunday, July 28, 13

50. Main
Abnormali3es
can
be
Suspected
on
Basic
Planes
31
Sunday, July 28, 13

51. 
Holoprosencephaly
Microcephaly
Head normal or small

Chiari
Malforma3on
ACC

Dia


Anencephaly
Occipital Encephalocele
Schizencephaly
Schizencephaly
Circle of Willis Mallformation
Vascular
Malforma3ons
SOP
Pilu
Imaging Findings
 Herniated brain tissue
 „cyst within the cyst“
 Ventriculomegaly 7080%
 Microcephaly 25%
 Polyhydramnios
 Oligohydramnios

Encephalocele
PF-­‐Fluid-­‐Cyst
CAVE:
 Associated with multiple
syndroms ( Meckel- Gruber )
Hydrance
halus , T 21
Ventriculomegaly
Hemimegalencephaly
Arachnoid
cyst
Hydranecphaly
Yong seok et a
32
Sunday, July 28, 13

52. 
Holoprosencephaly
Microcephaly
Head normal or small

Chiari
Malforma3on
ACC

Dia


Anencephaly
Occipital Encephalocele
Schizencephaly
Schizencephaly
Circle of Willis Mallformation
Vascular
Malforma3ons
SOP
Pilu
Imaging Findings
 Herniated brain tissue
 „cyst within the cyst“
 Ventriculomegaly 7080%
 Microcephaly 25%
 Polyhydramnios
 Oligohydramnios

Encephalocele
PF-­‐Fluid-­‐Cyst
CAVE:
 Associated with multiple
syndroms ( Meckel- Gruber )
Hydrance
halus , T 21
Ventriculomegaly
Hemimegalencephaly
Arachnoid
cyst
Hydranecphaly
Yong seok et a
32
Sunday, July 28, 13

53. 
Holoprosencephaly
Microcephaly
Head normal or small

Chiari
Malforma3on
ACC

Dia


Anencephaly
Occipital Encephalocele
Schizencephaly
Schizencephaly
Circle of Willis Mallformation
Vascular
Malforma3ons
SOP
Pilu
Imaging Findings
 Herniated brain tissue
 „cyst within the cyst“
 Ventriculomegaly 7080%
 Microcephaly 25%
 Polyhydramnios
 Oligohydramnios

Encephalocele
PF-­‐Fluid-­‐Cyst
CAVE:
 Associated with multiple
syndroms ( Meckel- Gruber )
Hydrance
halus , T 21
Ventriculomegaly
Hemimegalencephaly
Arachnoid
cyst
Hydranecphaly
Yong seok et a
32
Sunday, July 28, 13

54. 
Holoprosencephaly
Microcephaly
Head normal or small

Chiari
Malforma3on
ACC

Dia


Anencephaly
Occipital Encephalocele
Schizencephaly
Schizencephaly
Circle of Willis Mallformation
Vascular
Malforma3ons
SOP
Pilu
Imaging Findings
 Herniated brain tissue
 „cyst within the cyst“
 Ventriculomegaly 7080%
 Microcephaly 25%
 Polyhydramnios
 Oligohydramnios

Encephalocele
PF-­‐Fluid-­‐Cyst
CAVE:
 Associated with multiple
syndroms ( Meckel- Gruber )
Hydrance
halus , T 21
Ventriculomegaly
Hemimegalencephaly
Arachnoid
cyst
Hydranecphaly
Yong seok et a
32
Sunday, July 28, 13

55. •Ventriculomegaly
(hydrocephalus)
•Absent
Cavum
Septum
Pellucidum
•Agenesis
of
the
Corpus
Callosum
•Fluid
Collection
in
the
posterior
fossa
33
Sunday, July 28, 13

56. Ventriculomegaly
(hydrocephalus)
Mild
10
–
15
mm
Low
Risk
mean
=
6-­‐8
mm
Severe
>
15
mm
High
Risk
(<
10
mm
is
normal).
Independent
of
gesta7onal
age
Sunday, July 28, 13

57. Pathogenesis:
Ventriculomegaly
Lee
Lateral
Ventricle
Right
Lateral
Ventricle
Foramen
of
Monro
Aqueduct
of
Sylvius
4th
Ventricle
3rd
Ventricle
Cisterna
Magna
35
Sunday, July 28, 13

58. Absent
CSP
•Square
Shaped,
Interrupts
and
Fills
The
Space
Between
The
Frontal
Horns
•The
CSP:
Becomes
Visible
At
16
Weeks,
Obliterate
Near
Term
Sunday, July 28, 13

59. Absent
CSP
Cavum
Sep3
Pellucidi
•Square
Shaped,
Interrupts
and
Fills
The
Space
Between
The
Frontal
Horns
•The
CSP:
Becomes
Visible
At
16
Weeks,
Obliterate
Near
Term
Sunday, July 28, 13

60. Absent
CSP
A
rare
finding
usually
discovered
Postnatally
in
children
evaluated
for
developmental
delay.
Associated
with
various
brain
malformations:
agenesis
of
the
corpus
callosum
Holoprosencephaly.
Setpo-­‐optic
dysplasia.
Secondary
to
disruptive
process:
Hydrocephalus,
Chiari
II
malformation,
hydranecephaly.
Sunday, July 28, 13

61. Agenesis
of
the
Corpus
Callosum
38
Sunday, July 28, 13

62. 21-­‐week
Fetus
With
Par=al
Agenesis
Of
The
Corpus
Callosum
Only
The
Rostrum
(1),
Genu
(2)
And
Body
(3)
Are
Visible;
The
Splenium
Is
Missing.
The
Corpus
Callosum
Is
Short
Posteriorly
And
Does
Not
Seem
To
Overlay
The
Quadrigeminal
Plate
Sunday, July 28, 13

63. Outcome
of
fetal
ACC
 Va r i e s
b e t we e n
co m p l e te l y
a sy m p to m a 3 c
appearance
and
severe
neurologic
problems
 50
–
100
%
of
isolated
cases
will
have
normal
neurological
development
at
3-­‐11
years
but
Poor
prognosis
with
associated
anomalies

Progressive
decline
in
intellect
over
the
years

Most
need
special
educa3on
Long-­‐term
follow-­‐up
of
children
with
prenatally
diagnosed
agenesis
of
corpus
callosum
(ACC)
J.
H.
Stupin
et
al,
USOG,
32,
2008
Sunday, July 28, 13

64. Fluid
Collec3on
in
the
Posterior
Fossa
41
Sunday, July 28, 13

65. Fluid
Collec3on
in
the
Posterior
Fossa
•Megacisterna Magna
41
Sunday, July 28, 13

66. Fluid
Collec3on
in
the
Posterior
Fossa
•Megacisterna Magna
•Blak’s Pouch Cyst
41
Sunday, July 28, 13

67. Fluid
Collec3on
in
the
Posterior
Fossa
•Megacisterna Magna
•D-W Malformation &DW- Variant
•Blak’s Pouch Cyst
41
Sunday, July 28, 13

68. Fluid
Collec3on
in
the
Posterior
Fossa
•Megacisterna Magna
•Blak’s Pouch Cyst
•D-W Malformation &DW- Variant
•Arachnoid Cyst
41
Sunday, July 28, 13

69. Anomalies Of The
Meninges
•Megacisterna Magna
•Blak’s Pouch Cyst
Anomalies
Cerebellum
•D-W Malformation &DW- Variant
•Arachnoid Cyst
42
Sunday, July 28, 13

70. Mega–Cisterna Magna
An Enlargement Of The Cisterna Magna Beyond 10
Mm With Intact Vermis
43
Sunday, July 28, 13

71. Pathogenesis: Mega Cisterna Magna
Lateral
Ventricle
Third
Ventricle
Cerebral
Aqueduct
Choriod
Plexus
Fourth
Ventricle
44
Sunday, July 28, 13

72. Pathogenesis: Mega Cisterna Magna
The Foramina Of
Lateral
Ventricle
Luschka And Magendie
Fenestrate Delayed
Third
Ventricle
Cerebral
Aqueduct
Choriod
Plexus
Fourth
Ventricle
44
Sunday, July 28, 13

73. Prognosis:
• Isolated Cases: (97%-100%) Are Normal.
• If Not Isolated: Only 11% Have Normal Outcome.
Nonisolated Cases Have VM, Congenital Infection, Or
Karyotype Abnormalities.
A Large Cisterna Magna Require Careful Search For
Other Abnormalities.
45
Sunday, July 28, 13

74. Blake’s Pouch Cyst
46
Sunday, July 28, 13

75. Pathogenesis: Blake’s Pouch Cyst
Nonfenestration of the
foramina of Luschka and
Lateral
Ventricle
Magendie leads to dilatation
of the fourth ventricle and
and elevation of the vermis
away from the brain stem.
Third
Ventricle
Cerebral
Aqueduct
Choriod
Plexus
Fourth
Ventricle
There is no communication between the
cyst and the subarachnoid space
47
Sunday, July 28, 13

76. Pathogenesis: Blake’s Pouch Cyst
Nonfenestration of the
foramina of Luschka and
Lateral
Ventricle
Magendie leads to dilatation
of the fourth ventricle and
and elevation of the vermis
away from the brain stem.
Third
Ventricle
Cerebral
Aqueduct
Choriod
Plexus
Fourth
Ventricle
There is no communication between the
cyst and the subarachnoid space
47
Sunday, July 28, 13

77. Dandy-Walker Malformation
A Spectrum Of Anomalies Of The Posterior Fossa.
• Dandy-Walker Malformation:
✦Increase Of The Posterior Fossa,
✦Complete Or Partially Agenesis Of The Cerebellar
Vermis,
✦A Tentorium Elevation
• Variant Of Dandy-Walker:
✦Hypoplasia Of The Cerebellar
Vermis In Different
Degrees With Or Without Increase Of The Posterior
Fossa.
48
Sunday, July 28, 13

78. ctions
Dandy-Walker Malformation
Elevated tentorium and
high position of the
torcula
Small, rotated, raised,
or absent vermis
Cystic dilation of the
fourth ventricle
communicating with a
posterior fossa fluid
space
49
Sunday, July 28, 13

79. The Prognosis :
Better In Isolated DWS.
Karyotype Abnormalities In About 15%.
Neonatal Mortality:
12% To 55%.
Neonatal Morbidity:
•Intelligence Is Normal In About 40%
•Borderline In 20%
•Subnormal In 40%.
50
Sunday, July 28, 13

80. igure 2 2 Blake’s Pouch Cyst the torcular Herophili (arrows) inferred
the
Dandy–Walker Malformation
Figure The position ofof torcular Herophili (arrows) is is inferre
The position Normal
The Torcular Is Found In A
The Torcular Is
n ultrasound by the direction ofof the tentorium DisplacedIn In (a) th
tentorium cerebelli. Higher
Position, At About The Same Level
on ultrasound by the direction the Than Usual, Indicating That Thisthe
cerebelli. (a)
As The found
Insertion Of The
orcular isSitefound in normal position, A at about the same level as
torcular is OfOnin a Posterior position, about the same level as
a normal
Is at
Neck Muscles
The
he site ofof insertion of the neck muscles on the posterior skull; thi
insertion of the neck muscles on the posterior skull; this
Skull
the site
51
a Blake’s13pouch cyst. In (b) the torcular is displaced higher than
is a Blake’s pouch cyst. In (b) the torcular is displaced higher than
Sunday, July 28,

81. Arachnoid Cysts
•
Are Benign, Noncommunicating Fluid
Collections
Within
Arachnoid
Membranes.
•
Location: Intracranially And In The
Spinal Canal.
•
Order Of Frequency Are The Sylvian
Fissure Or Temporal Fossa, Posterior
Fossa, Over The Cerebral Convexity,
And Midline Supratentorial,
•
Most Appear Stable And Require No
Surgical Treatment. Occasionally They
Interfere With CSF Circulation And
Require Decompression.
Sunday, July 28, 13

82. The Differential Diagnosis
Depends On The Location.
In The Posterior Fossa:
DandyWalker Malformation, Inferior Vermian
Hypoplasia, Mega–cisterna Magna, And Blake’s Pouch
Cysts.
Supratentorial Cysts:
Cavum Veli Interpositi, Aneurysm Of Vein Of Galen,
Hemorrhage, And Cystic Tumors.
53
Sunday, July 28, 13

83. Prenatal diagnosis and outcome of fetal posterior
fossa fluid collections
G. GANDOLFI COLLEONI et al,
Ultrasound Obstet Gynecol 2012; 39: 625–631
54
Sunday, July 28, 13

84. 105
Fetuses
Blake’s Pouch Cyst
N = 32
Arachnoid Cyst
N=1
Megacisterna Magna
N = 27
Cerebellar Hypoplasia
N=2
Sonographic
diagnoses
were accurate
in 88%
Sunday, July 28, 13
Dandy – Walker Malformation
N=26
Vermian Hypoplasia
N=17
55

85. ✦ Isolated
Cases Of Blake’s Pouch Cyst And
Megacisterna Magna Have An Excellent Prognosis,
With A High Probability Of Intrauterine Resolution
And Normal Intellectual Development In Almost All
Cases.
✦ Dandy
– Walker Malformation And Vermian
Hypoplasia, Even When They Appear Isolated
Antenatally, Are Associated With An Abnormal
Outcome In Half Of Cases.
56
Sunday, July 28, 13

86. Conclusion
•Black’s
Pouch
Cyst,
DW
Malformation,
and
Mega-­‐Cisterna
Magna
Can
give
Similar
Sonographic
features.
•However
the
prognosis
is
greatly
varialbe.
•Careful
Neurosonographic
assessment
using
3
D
or
Fetal
MRI
is
often
Needed
57
Sunday, July 28, 13

87. Technical Guideline
How do we do it? Practical advice on imaging-based
techniques and investigations
Three dimensional ultrasound
examination of the fetal central
nervous system
Gianluigi Pilu, Tullio Ghi, Angela Carletti,
Maria Segata, Antonella Perolo, Nicola Rizzo
From the Department of Obstetrics and Gynecology
University of Bologna, Italy
Address for correspondence: gianluigi.pilu@unibo.it
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245
Sunday, July 28, 13

88. 3D
ultrasound
is
a
data
set
that
contains
a
large
number
o f
2 D
p l a n e s
( B -­‐ m o d e
images).
e.g.
If
the
page
of
a
book
is
one
2D
plane,
then
the
book
itself
is
the
en3re
data
set.
The
3
D
probe
acquire
the
data
by
moving
a
B
mode
transducer
within
a
housing
like
a
hand
held
Japanese
fan
.
Sunday, July 28, 13

89. Pyramid
Of
Volume
Informa=on
✴ “Walking”
through
the
volume
is
similar
to
leafing
through
the
pages
of
a
book
i.e.
walking
through
the
various
2D
planes
that
make
up
the
entire
volume.
✴ The
Volume
can
be
dissected
in
any
plane,
to
get
“Multiplanar
Imaging”
Sunday, July 28, 13
the
acquired
volume
unlike
the
defined
rectangle
shape
of
a
book
looks
like
a
pyramid
or
triangle
of
volume
informa3on
with
a
broad
base

90. 3D volumes of the fetal brain obtained from
an axial approach: the ‘start’ scan
Cavum septi pellucidi
midline
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245
61
Sunday, July 28, 13

91. midline
A
C
Sunday, July 28, 13
B
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245

92. midline
A
C
Sunday, July 28, 13
B
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245

93. midline
A
B
A and B rotated on Z
plane until midline is
aligned with C plane
C
Sunday, July 28, 13
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245

94. A
B
Corpus callosum + cavum septi pellucidi
Cerebellar vermis
C
Sunday, July 28, 13
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245
Acoustic shadow

95. midline
Corpus
callosum
Cavum
sep*
pellucidi
midline
Corpus
callosum
+
cavum
sep*
pellucidi
Originally
published
in
Ultrasound Obstet Gynecol 2007; 30: 233–245
Sunday, July 28, 13
64

96. Angled
Insona3on
of
Posterior
Fossa
to
Visualize
brain
Stem
4v
Brain
stem
Cerebellar
vermis
Originally
published
in
Ultrasound
Obstet
Gynecol
2007;
30:
233–245
Sunday, July 28, 13
65

97. hemisphere
hemisphere
tentorium
4v
vermis
hemisphere
hemisphere
tentorium
vermis
vermian fissures
4v
Sunday, July 28, 13
Originally published in Ultrasound Obstet Gynecol 2007; 30: 233–245

98. body
atrium
Occipital
horn
Temporal
horn
Sylvian
fissure
Originally
published
in
Ultrasound
Obstet
Gynecol
2007;
30:
233–245
Sunday, July 28, 13
67

99. 68
Sunday, July 28, 13

100. 69
Sunday, July 28, 13

101. 70
Sunday, July 28, 13

102. 71
Sunday, July 28, 13

103. 72
Sunday, July 28, 13

104. 73
Sunday, July 28, 13

105. Agenesis
of
the
corpus
callosum
Normal
corpus
callosum
3v
Absent
corpus
callosum
3v
Par3al
agenesis
3v
Originally
published
in
Ultrasound
Obstet
Gynecol
2007;
30:
233–245
Sunday, July 28, 13
74

106. Normal
Posterior
Fossa
At
Midgesta=on
Axial view
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

107. Normal
Posterior
Fossa
At
Midgesta=on
Cavum
Sep3
Pellucidi
Axial view
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

108. Normal
Posterior
Fossa
At
Midgesta=on
Cavum
Sep3
Pellucidi
Cerebellar
vermis
Axial view
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

109. Normal
Posterior
Fossa
At
Midgesta=on
Cisterna
Magna
Cavum
Sep3
Pellucidi
Cerebellar
vermis
Axial view
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

110. Normal
Posterior
Fossa
At
Midgesta=on
Cisterna
Magna
Cavum
Sep3
Pellucidi
Cerebellar
vermis
Tentorium
Axial view
Cisterna
Magna
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

111. Normal
Posterior
Fossa
At
Midgesta=on
Cisterna
Magna
Cavum
Sep3
Pellucidi
Cerebellar
vermis
Tentorium
Axial view
Cisterna
Magna
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

112. Normal
Posterior
Fossa
At
Midgesta=on
Cisterna
Magna
Cavum
Sep3
Pellucidi
Cerebellar
vermis
Tentorium
Axial view
Cisterna
Magna
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

113. Normal
Posterior
Fossa
At
Midgesta=on
Cisterna
Magna
Cavum
Sep3
Pellucidi
Cerebellar
vermis
Tentorium
Axial view
Cisterna
Magna
SagiGal
view
Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Sunday, July 28, 13

114. Applica=on
of
3
D
Imaging
in
Prenatal
diagnosis
of
Fetal
Posterior
Fossa
Fluid
Collec=on
76
Sunday, July 28, 13

115. Prenatal
diagnosis
and
outcome
of
fetal
posterior
fossa
fluid
Collec=ons
Gandolfi
Colleoni
et
al.,
UOG
2012
Brainstem–vermis and brainstem–tentorium angles allow accurate
categorization of fetal upward rotation of cerebellar vermis
P. VOLPE*, et al
Ultrasound Obstet Gynecol 2012; 39: 632–635
77
Sunday, July 28, 13

116. Categoriza3on
of
posterior
fossa
fluid
collec3ons
(1)
Sunday, July 28, 13

117. Categoriza3on
of
posterior
fossa
fluid
collec3ons
(1)
Blake’s
pouch
cyst
Upward
rotation
of
an
intact
vermis
with
normal
torcular
Findings
Megacisterna
magna
Cisterna
magna
>10mm
with
intact
and
normally
positioned
cerebellum
SagiGal
Axial
Sunday, July 28, 13
D-­‐W
Upward
rotation
of
the
vermis
(normal
or
hypoplastic)
with
elevated
torcular

118. Axial
View
• Transverse
Diameter Of
The Cerebellum.
• The Intactness And Size
Of The Vermis.
• The Depth Of The
Cisterna Magna (10 Mm)
Sunday, July 28, 13
79

119. Cavum
Sep3
Pellucidi
The
Tentorium:
Level
The
Vermis:
Shape,
Size,
Fissures
Figure 1 Measurement of brainstem–vermis (BV) and brainstem–tento
80
this case
Sunday, July 28, 13 after acquisition of an ultrasound volume starting from an axi

120. Cavum
Sep3
Pellucidi
Brainstem-tentorium
(BT) angle
Brainstem-vermis
Figure 1 Measurement of brainstem–vermis (BV) and brainstem–tento
(BV) angle
81
this case after acquisition of an ultrasound volume starting from an axi
Sunday, July 28, 13

121. 1 Measurement of brainstem–vermis and and brainstem–tentorium (BT) angles.median view of the of the fetal obtained (in
(a)
Measurement of brainstem–vermis (BV)(BV) brainstem–tentorium (BT) angles. (a) A(a) A A median viewfetal brain is brain is obta
Figure 1 Measurement of brainstem–vermis (BV) and brainstem–tentorium (BT) angles.
median view of the fetal brain is obtained
e after acquisitionan ultrasound volume starting from from an axial view) and theanatomic landmarks are identified. (b) A (b)
ter acquisition of of an ultrasound volume starting an axial axial and the main main anatomic landmarks are identified. lin
this case after acquisition of an ultrasound volume starting from anview) view) and the main anatomic landmarks are identified. (b) line i
A
angentially to dorsal aspect of the brain stem stema and a line is line is drawn tangentially to the contour of thethe cerebellar
dorsal aspect of of brain and and a second drawn tangentially to the the ventral contour of of the cerebe
gentially to the theto the dorsal aspectthe the brain stemsecondsecond line is drawn tangentially toventralventral contourcerebellar
drawn tangentially
the interposed angle is the BV BV BV angle; the BT angle (2) is measured between the first line andthird line tangential thethe tentoriu
interposed angle (1) (1) is the the angle; the BT (2) is measured between the first first line and a line tangential to to tentorium
vermis; the interposed angle (1) isangle; the BT angleangle (2) is measured between theline and a third a third line tangential to the te
Measurement Of Brainstem–vermis (BV) Angle (1) And
Brainstem–tentorium (BT) In Three Conditions
Blake’s Pouch
Cyst
Cerebellar Vermis
Hypoplasi
Dandy–Walker
Malformation.
The Angles Has The Widest Measurement In DA
Malformation
82
Figure 2 Measurement of brainstem–vermis (BV) angle (1) and brainstem–tentorium (BT) angle (2) in fetuses with: (a) Blake’s pouch cys
Sunday, July 28, 13

122. Blake’s pouch cyst
Dandy–Walker malformation
Vermian hypoplasia
Dandy–Walker malformation
12
12
7
12
23.0
63.5
34.9
63.5
Brainstem–vermis Angle
2.8
17.6
5.4
17.6
60
40
20
0
0
7.0
15.1
32–52
15.1
51–1
45–66
51–112
Brainstem– Tentorium Angle
Normal
Normal
Blake’s pouch Vermian Dandy–Walker
cyst
hypoplasia malformation
Blake’s pouch Vermian Dandy–Walker
cyst
hypoplasia malformation
Figure 3 Box-and-whisker plot of distribution of brainstem–vermis
angle in controls and in fetuses with upward rotation of the
cerebellar vermis. Medians of distribution line inside each box,
Figure 3 Box-and-whisker plot are indicated by a of brainstem–vermis
th
th
th
th
angle in25 and 75and in fetuses withlimits and 5 and 95 ofpercentiles
controls percentiles by box upward rotation the
by lower and upper bars, respectively.
Brainstem–tentorium angle (°)
Brainstem–tentorium angle (°)
Brainstem–vermis angle (°)
Brainstem–vermis angle (°)
20
67.2 7.1
80
80
40
42.2
52.1
67.2
80
80
60
19–26
45–112
24–40
45–112
60 60
40
40
20
20 Normal
Blake’s pouch
cyst
Normal
Vermian Dandy–Walker
hypoplasia malformation
Blake’s pouch
Vermian
Dandy–Walk
cyst
hypoplasia malformatio
Figure 4 Box-and-whisker plot of distribution of brainstem–
tentorium angle in controls and in fetuses with upward rotation of
the cerebellar vermis. Medians are indicated by a line inside each
Figure 4 Box-and-whisker plot of distribution of brainstem–
box, 25th and 75th percentiles by box limits and 5th and 95th
tentorium angle in controls respectively.
percentiles by lower and upper bars,and in fetuses with upward rotation o
Box-and-whisker plot of distribution of
Box-and-whisker indicated by line inside each of
cerebellar vermis. Medians are plot of a distribution box,
th and 75th percentiles by box limits and 5th and 95th percentiles
25
cerebellar vermis. Medians are in controls and in
brainstem–vermis angle in controls and in thebrainstem– tentorium angleindicated by a line inside each
by lower and upper bars, < 18◦ and a BT angle < 45◦ . The BV
th
had a BV angle respectively.
box, 25th and 75th upward rotation limits andcerebellarth
fetuses with percentiles by box of (BV) and and 95
the 5
fetuses with upward increased inof theofcerebellar Table 2 Statistical comparison ofupper bars, respectively.
angle was significantly rotation each
the three
percentiles by lower and brainstem–vermis
brainstem–tentorium (BT) angles in controls and in fetuses with
subgroups of anomalies
3, Table 2),
angle
vermis. Medians are indicated by a line inside
vermis. Medians and (Figure angle <a45◦theThe BV upward rotation of the cerebellar vermis
had a increasing with18◦ are indicated by condition. The
BV angle < increasing a BT of the line inside
.
severity
each box, 25th and 75th of brainstem–vermis (BV) and
Table 2 Statistical comparison percentiles by box limits
BT angle 25th and similar pattern, of by box
angle was significantly increased percentilesthere was
each box, demonstrated a75th in each but the three
P (Mann–Whitney U-test)
brainstem–tentorium (BT) angles in controls and in fetuses with
more of anomalies (Figure (Figure 4, Table 2).
subgroups overlapping among groups3, Table 2), the angle
th and of the percentiles by lower and upper
th cerebellar vermis
and
upward5
limits and 5th and 95th percentiles by lower Comparison*rotation 95
BV angle
BT angle
increasing with increasing severity of the condition. The
BT and upper S I O N respectively.
angle Sdemonstrated a similar pattern, but there was
D I C U S bars,
more overlapping among groups (Figure 4, Table 2).
Our results suggest that measurement of the BV angle
discriminates
Sunday, July 28, 13 accurately posterior fossa fluid collections
bars, respectively.
Controls vs Blake’s pouch cyst
fetuses
Controls vs Dandy–Walker
Comparison*
fetuses
< 0.00000005 (Mann–Whitney U-test)
P < 0.000005
< 0.00000005 < 0.00000005
BV angle
BT angle

123. Conclusion
Fetal posterior fossa fluid collections associated
with upward rotation of the cerebellar vermis range
from benign asymptomatic conditions to severe
abnormalities associated with neurological
impairment.
The most frequent of these anomalies, Blake’s
pouch cyst, vermian hypoplasia and Dandy–
Walker malformation, have a similar sonographic
appearance but a very different prognosis
84
Sunday, July 28, 13

124. In
Summary
85
Sunday, July 28, 13

125. Examination Of The Posterior Fossa And
The Cerebellum
Axial View
Midsagittal Views
86
Sunday, July 28, 13

126. Prac3cal
Approach
to
the
DD
of
Posterior
Fossa
Cyst
and
Cys3c
like
Lesions
Sunday, July 28, 13

127. Prac3cal
Approach
to
the
DD
of
Posterior
Fossa
Cyst
and
Cys3c
like
Lesions
1. Is
the
Vermis
Present?Is
the
Vermis
intact?
Sunday, July 28, 13

128. Prac3cal
Approach
to
the
DD
of
Posterior
Fossa
Cyst
and
Cys3c
like
Lesions
1. Is
the
Vermis
Present?Is
the
Vermis
intact?
2. Is
the
Toruclar
in
a
normal
posi3on
(tentorial
Cerebelli)?
Sunday, July 28, 13

129. Prac3cal
Approach
to
the
DD
of
Posterior
Fossa
Cyst
and
Cys3c
like
Lesions
1. Is
the
Vermis
Present?Is
the
Vermis
intact?
2. Is
the
Toruclar
in
a
normal
posi3on
(tentorial
Cerebelli)?
3. What
is
the
shape
of
the
cerebellar
clee?
Sunday, July 28, 13

130. Prac3cal
Approach
to
the
DD
of
Posterior
Fossa
Cyst
and
Cys3c
like
Lesions
1. Is
the
Vermis
Present?Is
the
Vermis
intact?
2. Is
the
Toruclar
in
a
normal
posi3on
(tentorial
Cerebelli)?
3. What
is
the
shape
of
the
cerebellar
clee?
4. Brainstem–vermis (BV) Angle And Brainstem–
tentorium (BT) Angle
Sunday, July 28, 13

131. Blacke’s
Pouch
Cyst
Cystegacisterna
Magna
Ultrasound Obstet Gynecol 2012; 39: 625–631
Published online 14 May 2012 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.11071
Prenatal diagnosis and outcome of fetal posterior fossa fluid
collections
G. GANDOLFI COLLEONI*, E. CONTRO*, A. CARLETTI*, T. GHI*, G. CAMPOBASSO†,
G. REMBOUSKOS†, G. VOLPE‡, G. PILU* and P. VOLPE†
Vermian
Hypoplasia
D-­‐W
Malforma3on
*Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy; †Fetal Medicine Unit, Di Venere and Sarcone Hospitals,
ASL Bari, Bari, Italy; ‡Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
K E Y W O R D S: cerebellar anomalies; Dandy–Walker malformation; fetus; megacisterna magna; prenatal diagnosis; ultrasound
ABSTRACT
Cerebellar
Hypoplasia
Objective To evaluate the accuracy
of fetal imaging
in differentiating between diagnoses involving posterior
fossa fluid collections and to investigate the postnatal
outcome of affected infants.
Methods This was a retrospective study of fetuses with
posterior fossa fluid collections, carried out between 2001
and 2010 in two referral centers for prenatal diagnosis. All
fetuses underwent multiplanar neurosonography. Parents
were also offered fetal magnetic resonance imaging (MRI)
and karyotyping. Prenatal diagnosis was compared with
autopsy or postnatal MRI findings and detailed follow-up
was attempted by consultation of medical records and
interview with parents and pediatricians.
fluid collections from mid gestation. Blake’s pouch cyst
and megacisterna magna are risk factors for associated
anomalies but when isolated have an excellent prognosis,
with a high probability of intrauterine resolution and
normal intellectual development in almost all cases.
Conversely, Dandy–Walker malformation and vermian
hypoplasia, even when they appear isolated antenatally,
are associated with an abnormal outcome in half of cases.
Copyright © 2012 ISUOG. Published by John Wiley &
Sons, Ltd.
Arachinoid
Cyst-­‐Pos
Fossa
INTRODUCTION
88
Fluid collections in the fetal posterior fossa encompass
a wide spectrum of different megacisterna magna;
Figure 1 Categorization of posterior fossa fluid collections on ultrasound: (a,b) Blake’s pouch cyst; (c,d) entities, ranging from(e,f) vermian
Sunday, July 28, 13 During the study period, 105 fetuses were examnormal variants to severe anomalies1 . fossa.
hypoplasia; (g,h) Dandy–Walker malformation; (i,j) cerebellar hypoplasia; (k,l) arachnoid cyst of the posterior They may have
Results

132. Normal
Megacisterna
magna
Blake’s
pouch
cyst
tentorium
Vermian
hypoplasia
Dandy-­‐Walker
malforma3on
Originally
published
in
Ultrasound
Obstet
Gynecol
2007;
30:
233–245
Sunday, July 28, 13
89

133. Take
Home
Message
Standard
and
Fetal
Neurosonography
90
Sunday, July 28, 13

134. 91
Sunday, July 28, 13

135. ✦ examina3on
of
the
Fetal
CNS
should
be
follow
a
Standard
Protocol
91
Sunday, July 28, 13

136. ✦ examina3on
of
the
Fetal
CNS
should
be
follow
a
Standard
Protocol
✦ Examina3on
should
include
at
least
three
axial
planes.
91
Sunday, July 28, 13

137. ✦ examina3on
of
the
Fetal
CNS
should
be
follow
a
Standard
Protocol
✦ Examina3on
should
include
at
least
three
axial
planes.
✦ In
Each
plane
the
defined
landmarks
should
should
be
reported
as
normal
or
suspicious
91
Sunday, July 28, 13

138. ✦ examina3on
of
the
Fetal
CNS
should
be
follow
a
Standard
Protocol
✦ Examina3on
should
include
at
least
three
axial
planes.
✦ In
Each
plane
the
defined
landmarks
should
should
be
reported
as
normal
or
suspicious
✦ In
the
presence
of
possible
abnormali3es
pa3ent
should
be
referred
for
detailed
neuorsonogram
which
include
mutli-­‐planner
3
D
Sanning.
91
Sunday, July 28, 13

139. ✦ examina3on
of
the
Fetal
CNS
should
be
follow
a
Standard
Protocol
✦ Examina3on
should
include
at
least
three
axial
planes.
✦ In
Each
plane
the
defined
landmarks
should
should
be
reported
as
normal
or
suspicious
✦ In
the
presence
of
possible
abnormali3es
pa3ent
should
be
referred
for
detailed
neuorsonogram
which
include
mutli-­‐planner
3
D
Sanning.
✦ 3
D
scanning
with
mul3planner
analysis
offers
comparable
analysis
to
fetal
MRI
91
Sunday, July 28, 13

140. Thanks
92
Sunday, July 28, 13