Neurosonography through the fontanel

Neurosonography through the fontanelle is a non-invasive ultrasound examination used to evaluate brain structures in infants while the fontanelle remains open. The fontanelle provides a natural “acoustic window” that allows intracranial structures to be visualized using ultrasound.

The examination provides information about the structure and development of the brain, the size of the cerebral ventricles, cerebrospinal fluid spaces, and certain abnormalities that may develop during the prenatal period, during birth, or after birth.

Neurosonography does not use ionizing radiation, is painless, and can be repeated when follow-up monitoring is required.

Indications

• prematurity;
• low birth weight;
• difficult delivery or birth trauma;
• suspected intracranial hemorrhage;
• perinatal hypoxia or asphyxia;
• rapid or unusual increase in head circumference;
• changes in the shape or size of the head;
• bulging or tense fontanelle;
• seizures or other neurological manifestations;
• changes in muscle tone;
• delayed or atypical neuropsychomotor development;
• suspected hydrocephalus or other abnormalities of the ventricular system;
• suspected congenital malformations of the central nervous system;
• congenital or perinatal infections with possible neurological involvement;
• monitoring of previously diagnosed intracranial abnormalities;
• recommendation by a pediatrician, neonatologist, or pediatric neurologist.

Procedure

The examination is performed using an ultrasound transducer, which is gently positioned over the fontanelle, most commonly the anterior fontanelle. A small amount of ultrasound gel is applied to the area being examined.

The physician examines the brain structures in different planes and, depending on the clinical indication, evaluates the cerebral ventricles, midline structures, brain tissue, and cerebrospinal fluid spaces.

The examination is painless, does not involve exposure to ionizing radiation, and usually takes only a few minutes.

Limitations

The quality and feasibility of the examination depend on the size of the fontanelle and the availability of an adequate acoustic window. As the fontanelle closes, ultrasound assessment of intracranial structures becomes increasingly limited.

Neurosonography does not replace all other brain imaging methods. In certain situations, the physician may recommend additional examinations, such as magnetic resonance imaging (MRI) or computed tomography (CT), to clarify the diagnosis.

The results should be interpreted in conjunction with the child’s age, medical history, clinical findings, and the results of other investigations.

Contraindications

Neurosonography through the fontanelle generally has no absolute contraindications.

In the presence of skin lesions, inflammation, or infection in the fontanelle area, the physician may decide to postpone or adapt the examination depending on the clinical situation.

Advantages

• non-invasive and painless method;
• does not use ionizing radiation;
• can be performed from the neonatal period;
• allows real-time evaluation of intracranial structures;
• can be repeated for follow-up monitoring;
• does not require sedation;
• is performed quickly and is generally well tolerated by infants.

Sources:

https://www.dovemed.com/health-topics/focused-health-topics/neurosonography-assessment-protocols-and-interpretation-diagnostic-accuracy
https://radiologykey.com/neurosonography/
https://ultrasoundschoolsguide.com/neurosonography/
https://www.ncbi.nlm.nih.gov/books/NBK573073/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247508/

IMPORTANT!

It is very important to remember that the information provided in this section is not intended for self-diagnosis or self-treatment. If you experience pain or an exacerbation of a medical condition, you should consult a physician for appropriate diagnostic investigations. Only a qualified healthcare professional can make an accurate diagnosis and determine the appropriate treatment.

For the most accurate and consistent assessment of test results, it is recommended that tests be performed at the same laboratory. This is because different laboratories may use different testing methods and units of measurement for similar tests.