Abstract
Ultrasound diagnosis of posterior fossa malformations in the prenatal period is a challenge, having major implications for the counseling and follow-up of pregnant women. The purpose of this study was to review aspects of the ultrasound evaluation of the fetal posterior fossa, as well as to describe the most relevant ultrasound findings of the main posterior fossa malformations that can affect the fetus in the prenatal period.
Highlights
Ultrasound diagnosis of posterior fossa malformations in the prenatal period is a challenge, having major implications for the counseling and follow-up of pregnant women
The most important plane for evaluating the fetal posterior fossa by ultrasound is the median sagittal plane. In this plane (Figure 3), it is possible to identify the brainstem; to assess the morphology of the cerebellar vermis by biometry; to evaluate the fourth ventricle and its fastigium; to identify the primary fissure, which divides the vermis into its superior and inferior portions, being an important marker for changes in its development, and should be identified in 100% of cases after week 24 of gestation; to evaluate the cisterna magna; and to determine the position of the tentorium, which is an important marker for the differential diagnosis of cystic malformations of the posterior fossa
Three fundamental factors hinder the ultrasound diagnosis of posterior fossa malformations: such malformations encompass a broad spectrum of different entities, ranging from normal variants to severe anomalies, which can present with similar findings on fetal ultrasound; the terminology employed in describing these anomalies varies; and the method of evaluating the posterior fossa structures during gestation, which is routinely performed in the axial planes of the fetal skull by ultrasound, is inappropriate
Summary
Ultrasound diagnosis of posterior fossa malformations in the prenatal period is a challenge, having major implications for the counseling and follow-up of pregnant women. These malformations encompass a wide spectrum of entities, ranging from normal variants to severe anomalies, often with similar aspects on fetal ultrasound; a variety of terms are used in order to describe these anomalies, without a uniform approach to their description; and the method of evaluating the posterior fossa structures during gestation, which is routinely performed in the axial planes of the fetal skull by ultrasound, is inappropriate[1,2,3]. The objective of this study was to review aspects of ultrasound evaluation of the fetal posterior fossa, with an emphasis on the neurosonographic aspects, as well as to describe the most relevant prenatal ultrasound findings of the main posterior fossa malformations that can affect the fetus
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