Learning objectives
To tell how to perform mastoid fontanel imaging
To display the normal anatomy seen from the mastoid fontanel view
To demonstrate pitfalls and artifacts of the mastoid fontanel imaging
To show pathologies of the posterior fossa that can be evaluated with mastoid fontanel imaging
To emphasize clinical conditions that adding this approach would help diagnosis and patient management.
Background
Survival rates for preterm infants have risen dramatically owing to the latest prenatal and postnatal treatments and modern,
well-equipped and well-staffed neonatal intensive care units (1).
Cranial sonography (US) is the primary imaging technique for evaluation of the brain in these patients (2-4).
Although anterior fontanel imaging is the main imaging approach of the neonatal cranial US,
this traditional approach has some limitations in demonstrating posterior fossa pathologies (5).
The mastoid fontanel is the thinnest region of the temporal bone at the junction of the...
Findings and procedure details
For performing mastoid fontanel imaging and evaluating the imaging findings properly,
we should know the answers of these questions.
How to perform themastoid fontanel imaging?
Use portable ultrasonography machine: The ultrasonography machine should be portable to allow bedside examinations.
It should be equipped with appropriate transducers,
especially with a high resolution transducer for neonatal head,
Doppler function and a storage system.
Obey the neonatal intensive care (NICU) rules: Especially the hygiene rules of the neonatal NICU should be obeyed.
The probe should be cleaned before...
Conclusion
For mastoid fontanel imaging,
place the transducer behind the ear,
slightly moved the transducer until a good view of the posterior fossa is obtained.
The whole posterior fossa,
thalami,
midbrain,
third ventricle,
and part of the brain cerebellar hemispheres and lateral ventricles can be demonstrated by tilting the transducer gently upward and downward.
The normal anatomy observed through the mastoid fontanel should be familiar with for early and accurate diagnosis.
Enlarged foramen of Magendi,
mega cistern magna and artifacts of the occipital bones should not...
Personal information
Yeliz Pekcevik,
MD
Tepecik Training and Research Hospital,
Department of Radiology,
Izmir,
Turkey
Fatma Ceren Sarioglu,
MD
Tepecik Training and Research Hospital,
Department of Radiology,
Izmir,
Turkey
Hilal Sahin,
MD
Tepecik Training and Research Hospital,
Department of Radiology,
Izmir,
Turkey
References
References:
Doyle LW,
Anderson PJ.
Adult outcome of extremely preterm infants.
Pediatrics 2010;126:342.
Lowe LH,
Bailey Z.
State-of-the-art cranial sonography: Part 1,
modern techniques and image interpretation.
AJR Am J Roentgenol 2011;196:1028.
Daneman A,
Epelman M,
Blaser S,
et al.
Imaging of the brain in full-term neonates: does sonography still play a role? Pediatr Radiol 2006;36:636.
Epelman M,
Daneman A,
Kellenberger CJ,
et al.
Neonatal encephalopathy: a prospective comparison of head US and MRI.
Pediatr Radiol 2010;40:1640.
Di Salvo DN.
A new view of the...