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

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

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

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

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

6. 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)

7. 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

8. 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

9. Coronal – Frontal lobes

10. Coronal – Frontal horns of the lateral ventricles

11. Coronal – Bodies of the lateral ventricles

12. Coronal – Trigone of the lateral ventricles

13. Coronal – Posterior to the trigone of the lateral ventricles

14. Sagittal – Midline

15. Sagittal – Long axis lateral ventricle

16. Sagittal – Lateral to the lateral ventricles

17. 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

18. 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)

19. 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)

20. Hydrocephalus

21. Hydrocephalus

22. Hydrocephalus – Treatment

23. Hydrocephalus – Treatment
Before and after shunt placement

24. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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