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Sonographic Visualization of Neonatal Posterior Fossa Abnormalities Through the Posterolateral Fontanelle

¹ Kaiser Permanente, 4647 Zion Ave., San Diego, CA 92120.
² Department of Radiology, University of California, 505 Parnassus Ave., M-396, San Francisco, CA 94143-0628.

View larger version (159K): [in a new window]   Fig. 1A. —5-day-old premature male neonate born at 25 weeks' gestation. Sonogram obtained through posterolateral fontanelle shows normal cerebellar hemispheres (c), echogenic cerebellar vermis (curved arrow), and fourth ventricle (straight arrow). L=left.

View larger version (159K): [in a new window]   Fig. 1B. —5-day-old premature male neonate born at 25 weeks' gestation. Sonogram obtained 3 days later through anterior fontanelle approach shows possible left hemorrhage (arrow).

View larger version (166K): [in a new window]   Fig. 1C. —5-day-old premature male neonate born at 25 weeks' gestation. Posterolateral fontanelle image obtained on same day as B shows unequivocal left cerebellar hemorrhage (arrows). It=left, rt=right.

View larger version (167K): [in a new window]   Fig. 2A .—3-day-old premature female neonate born at 27 weeks' gestation. Posterolateral fontanelle images more sensitively detect cerebellar hemorrhage. Anterior fontanelle images do not show posterior fossa hemorrhage. R = right.

View larger version (162K): [in a new window]   Fig. 2B .—3-day-old premature female neonate born at 27 weeks' gestation. Posterolateral fontanelle images more sensitively detect cerebellar hemorrhage. Posterolateral fontanelle images in same patient, same day, show unequivocal echogenic unilateral hemorrhage (arrow) in cerebellum. L = left, R = right.

View larger version (159K): [in a new window]   Fig. 3A. —8-day-old male neonate in whom cerebellar hemorrhage is better seen on posterolateral fontanelle images. Coronal image obtained through anterior fontanelle fails to show cerebellar abnormality (arrow).

View larger version (149K): [in a new window]   Fig. 3B. —8-day-old male neonate in whom cerebellar hemorrhage is better seen on posterolateral fontanelle images. Midline sagittal image obtained through anterior fontanelle shows questionable cerebellar abnormality (arrow).

View larger version (151K): [in a new window]   Fig. 3C. —8-day-old male neonate in whom cerebellar hemorrhage is better seen on posterolateral fontanelle images. Posterolateral fontanelle image clearly shows bilateral cerebellar hemorrhages (arrows). Neonate died of complications of necrotizing enterocolitis and did not undergo either autopsy or MR imaging.

View larger version (132K): [in a new window]   Fig. 4A. —Large intraventricular and extraaxial hemorrhage in 7-day-old premature male neonate born at 32 weeks' gestation. Posterolateral fontanelle image shows extraaxial hemorrhage (thick arrow and cursors) and clot in fourth ventricle (thin arrow).

View larger version (180K): [in a new window]   Fig. 4B. —Large intraventricular and extraaxial hemorrhage in 7-day-old premature male neonate born at 32 weeks' gestation. Anterior fontanelle image shows neither of the findings in posterior fossa (arrow) seen in A.

View larger version (148K): [in a new window]   Fig. 5A. —False-positive sonographic diagnosis of inferior vermian agenesis in 4-day-old male neonate. False-positive inferior vermian agenesis (arrow) shown on posterolateral fontanelle image.

View larger version (160K): [in a new window]   Fig. 5B. —False-positive sonographic diagnosis of inferior vermian agenesis in 4-day-old male neonate. Midline sagittal image obtained through anterior fontanelle shows intact vermis (curved arrows), retrospectively appreciated, covering fourth ventricle (straight arrow). MR imaging showed normal cerebellum.

View larger version (122K): [in a new window]   Fig. 6A. —1-day-old male neonate with inferior vermian agenesis. Posterolateral fontanelle image shows inferior vermian defect (arrow) that was associated with agenesis of corpus callosum (not shown).

View larger version (148K): [in a new window]   Fig. 6B. —1-day-old male neonate with inferior vermian agenesis. Midline sagittal anterior fontanelle image reveals possible inferior vermian agenesis. Note poor covering of fourth ventricle (long arrow) by vermis (curved arrows). Also note that partial voluming of small part of contralateral cerebellar hemisphere (small arrow) can be mistaken for intact vermis. Inferior vermian defect was confirmed on MR imaging.

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