Neonatal Head Ultrasound: Hydrocephalus Jenelle Beadle, RDMS Inland Imaging May 2017

Hydrocephalus Buildup of cerebrospinal fluid (CSF) within the ventricular system of the brain Exerts pressure on the brain that may cause damage

Hydrocephalus Aqueductal stenosis: Aqueduct of Sylvius is obstructed most common cause of congenital hydrocephalus

Hydrocephalus Aqueductal stenosis: Aqueduct of Sylvius is obstructed most common cause of congenital hydrocephalus Infection Hemorrhage Tumor

Hydrocephalus Less commonly, hydrocephalus may be caused by poor absorption or overproduction of CSF

Neurosonography – US Protocol Preparation Sterile, warm gel Technique x2 primary sonographic windows – Anterior & Posterior Fontanelles Anterior Fontanelle (closes at 9-18mos) Posterior Fontanelle (closes at 2-3mos)

Neurosonography – US Protocol Preparation Sterile, warm gel Technique x2 primary sonographic windows – Anterior & Posterior Fontanelles Neonatal head transducer If there is not one available, a 9L (or similar) works well

Neurosonography – US Protocol Preparation Sterile, warm gel Technique x2 primary sonographic windows – Anterior & Posterior Fontanelles Neonatal head transducer Light touch – only enough pressure to maintain contact

Coronal – Frontal lobes

Coronal – Frontal horns of the lateral ventricles

Coronal – Bodies of the lateral ventricles

Coronal – Trigone of the lateral ventricles

Coronal – Posterior to the trigone of the lateral ventricles

Sagittal – Midline

Sagittal – Long axis lateral ventricle

Sagittal – Lateral to the lateral ventricles

Hydrocephalus – US Measurements Levene Index – <40wks GA Distance between the falx & the lateral wall of the anterior horn Coronal plane at the level of the 3rd ventricle

Hydrocephalus – US Measurements Levene Index – <40wks GA Distance between the falx & the lateral wall of the anterior horn Coronal plane at the level of the 3rd ventricle Ventricular Index – >40wks GA Frontal Horn Ratio – distance between the lateral walls of the ventricles and the biparietal diameter (BPD)

Hydrocephalus – US Measurements Levene Index – <40wks GA Distance between the falx & the lateral wall of the anterior horn Coronal plane at the level of the 3rd ventricle Ventricular Index – >40wks GA Frontal Horn Ratio – distance between the lateral walls of the ventricles and the biparietal diameter (BPD)

Hydrocephalus

Hydrocephalus

Hydrocephalus – Treatment

Hydrocephalus – Treatment Before and after shunt placement

Neurosonography – US Protocol Image Requirements Coronal – x6 images (x1 cine – anterior to posterior) Orientation – Right brain on the left side of the image Imaged from anterior to posterior Sagittal – x12 images (x2 cines – left to midline & midline to right) Orientation – Anterior brain on the left side of the image Imaged from left to right

Coronal – x6 images (x1 cine – anterior to posterior)

Coronal – x6 images (x1 cine – anterior to posterior)

Coronal – x6 images (x1 cine – anterior to posterior)

Coronal – x6 images (x1 cine – anterior to posterior)

Coronal – x6 images (x1 cine – anterior to posterior)

Coronal – x6 images (x1 cine – anterior to posterior)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)

Sagittal – x12 images (x2 cines – left to midline & midline to right)