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CRANIAL ULTRASOUND ANATOMY OVERVIEW - keywords
CUS anatomy sfs r e f e r e n c e s anterior to the genu of the corpus callosum the interhemispheric fissure is undisturbed; this is the section to best study abnormal interdigitation of the hemispheres ihf interhemispheric fissure sfs sulcus frontalis superior sol sulcus orbitalis lateralis n a v i g a t o r ihf sol > far anterior coronal orbit < cranial ultrasound anatomy coronal sections anterior coronal coronal post-atrial coronal at the atria coronal @ Monro far posterior coronal coronal @ VL thalamus c sulcus precentralis medialis calc sulcus calcarinus cing sulcus cinguli  f1 sulcus frontalis superior f2 sulcus frontalis medius f3 sulcus frontalis inferior fl ramus posterior fissurae lateralis fm sulcus frontomarginalis (Wernicke)  h ramus horizontalis of pci lun sulcus lunatus olf sulcus and tractus olfactorius paracing sulcus paracinguli pci sulcus precentralis inferior  pcm sulcus precentralis medius pcs sulcus precentralis superior  po sulcus parieto-occipitalis poc sulcus postcentralis PT pars triangularis ra ramus ascendens fissurae lateralis rh ramus horizontalis fissurae lateralis Retzius 1896 fm sulcus frontomarginalis (Wernicke)  olf sulcus and tractus olfactorius ra ramus ascendens fissurae lateralis rh ramus horizontalis fissurae lateralis scoll sulcus collateralis sol sulcus orbitalis lateralis som sulcus orbitalis medialis sotr sulcus orbitalis transversus sot sulcus occipito-temporalis sr sulcus rhinalis rsm ramus supramarginalis sulci cinguli sang sulcus angularis sc sulcus centralis (Rolando) scoll sulcus collateralis sd sulcus diagonalis (Eberstaller) sip sulcus intraparietalis  soa sulcus occipitalis anterior soi sulcus occipitalis inferior sol sulcus orbitalis lateralis som sulcus orbitalis medialis sotr sulcus orbitalis transversus sot sulcus occipito-temporalis spa sulcus paracentralis sr sulcus rhinalis sri sulcus rostralis inferior srs sulcus rostralis superior ssa sulcus subcentralis anterior ssp sulcus subcentralis posterior sspa sulcus subparietalis st sulcus occipitalis transversus (Ecker) sts sulcus temporalis superior sti sulcus temporalis inferior gti olf cing in front of the foramen of Monro there is no choroid plexus; the anterior insular border becomes visible cing sulcus cinguli gr gyrus rectus gti gyrus transversus insulae ihf interhemispheric fissure lv lateral ventricle olf sulcus olfactorius gr lv 1 medial 2 anterior 3 posterior 4 lateral orbital gyri PP planum polare PT planum temporale H Heschl gyri (transverse gyri) matrix areas insula cranial ultrasound 2D anatomy (para)sagittal sections midline frontal surface deep grey matter most images were collected from preterm infants at PMA 34-37 weeks, with a microconvex probe around 8-10 MHz unless otherwise specified <—— structures <—— convexity primary sulci <—— mesial primary sulci <—— for many aspects, gross anatomy reflects brain function <—— overview mastoid <—— all primary sulci posterior fontanel nuchal <—— Retzius 1896 references temporal <—— Cunningham 1892 <—— summary posterior fontanel sections <—— sulci and Brodmann areae mastoid posterior fontanel nuchal temporal csp sfm cc corpus callosum cing sulcus cinguli csp cavum septi pellucidi gti gyrus transversus insulae ihf interhemispheric fissure lv lateral ventricle mc migrating cells sfm sulcus frontalis medius sfs sulcus frontalis superior sis sulcus circularis insulae superior mc cc temporal pole in the midline the anterior tip of tela choroidea, as it turns around into the plexus of the lateral ventricle, becomes visible in the section at the foramen of Monro; underneath it the third ventricle cavity may appear as a darker vertical slit, above it is cavum septi pellucidi; the anterior portion of temporal lobes is visible scis scoll cm coronal at ventrolateral thalamus cc corpus callosum cing sulcus cinguli cm cisterna magna ft fissura transversa (Bichat) ihf interhemispheric fissure lf lateral fissure lv lateral ventricle pci sulcus precentralis inferior scoll sulcus collateralis sfm sulcus frontalis medius sfs sulcus frontalis superior sis sulcus circularis insulae superior vlt ventrolateral thalamus ft vlt halfway between Monro and the choroid glomus, the ventrolateral and ventral posterior nuclei of thalamus appear as a mildly hyperechoic column, bordered by the darker ribbon of the posterior limb of the internal capsule; the sulcus collateralis is the floor of the parahippocampal gyrus pci lf cerebellar hemisphere temporal lobe cc corpus callosum near splenium cing sulcus cinguli cp choroid plexus ihf interhemispheric fissure lf lateral fissure lv lateral ventricle or optic radiation sfm sulcus frontalis medius sfs sulcus frontalis superior sts sulcus temporalis superior coronal at atrial level between the upper atrium and the lateral fissure runs the optic radiation (best observed before 37w PMA); the lateral fissure remains visible posterior to the sulcus circularis superior of the insula cp sts or rsm po ---- parietal lobe ----- calc poc calc sulcus calcarinus ihf interhemispheric fissure pcs sulcus precentralis superior po sulcus parieto-occipitalis poc sulcus postcentralis rsm ramus supramarginalis sulci cinguli sc sulcus centralis sts sulcus temporalis superior pcs coronal behind the atria sc white matter posterior to the atria is homogeneously hyperechoic, rostral to the sulcus parieto-occipitalis and calcar avis; in many infants the three vertical (peri)central sulci can be visualized; the ramus supramarginalis sulci cinguli always ends at the hemisphere margin and points in the direction of the sulcus postcentralis coronal far posterior sip ssp ihf interhemispheric fissure po sulcus parieto-occipitalis poc sulcus postcentralis rsm ramus supramarginalis sulci cinguli sc sulcus centralis sip sulcus intraparietalis ssp sulcus subparietalis in a far posterior section the sulcus intraparietalis can be visualised, dividing the parietal lobe in a superior (medial) and inferior (lateral) lobule Cunningham 1892 3D mesh model of primary gyration according to descriptions by Cunningham 1892 primary sulci: convexity f1 sulcus frontalis superior f2 sulcus frontalis medius f3 sulcus frontalis inferior fl ramus posterior fissurae lateralis fm sulcus frontomarginalis (Wernicke)  h ramus horizontalis of pci he Heschl gyri j Jensen anterior inferior partietal sulcus lun sulcus lunatus olf sulcus and tractus olfactorius pci sulcus precentralis inferior  pcs sulcus precentralis superior  po sulcus parieto-occipitalis poc sulcus postcentralis PT pars triangularis ra ramus ascendens fissurae lateralis rh ramus horizontalis fissurae lateralis sang sulcus angularis sc sulcus centralis (Rolando) sd sulcus diagonalis (Eberstaller) sip sulcus intraparietalis  soa sulcus occipitalis anterior soi sulcus occipitalis inferior spt sulcus parietalis transversus (Brissaud) ssa sulcus subcentralis anterior ssp sulcus subcentralis posterior st sulcus occipitalis transversus (Ecker) sts sulcus temporalis superior sti sulcus temporalis inferior calc sulcus calcarinus cing sulcus cinguli  olf sulcus and tractus olfactorius paracing sulcus paracinguli po sulcus parieto-occipitalis rsm ramus supramarginalis sulci cinguli sc sulcus centralis (Rolando) scc sulcus corporis callosi scoll sulcus collateralis sh sulcus hippocampi sol sulcus olfactorius sot sulcus occipito-temporalis spa sulcus paracentralis spt sulcus parietalis transversus (Brissaud) sr sulcus rhinalis srs sulcus rostralis superior ssp sulcus subparietalis primary sulci: mesial ssp vermis po v4 g s calc srs cm mid sagittal ic the mid sagittal section has the complete corpus callosum and vermis inferior plus superior, with the cisterna magna and a sulcus parieto-occipitalis from one hemisphere; the sulcus calcarinus variably leaves the latter in the direction of the occipital pole; cingulum (part of the limbic system) surrounds corpus callosum up to its isthmus cq calc sulcus calcarinus cing sulcus cinguli cm cisterna magna cq cisterna quadrigemina g genu corporis callosi ic isthmus cinguli po sulcus parieto-occipitalis rsm ramus supramarginalis sulci cinguli s splenium corporis corporis callosi srp sulcus rostralis superior ssp sulcus subparietalis t tela choroidea only millimeters parasagittal of the midline, the caudothalamic groove is visualised; it contains matrix in preterms, which is echo poor unless affected by disease; matrix cavitation is often present here parasagittal @ matrix ctg cing sulcus cinguli ctg caudothalamic groove g genu corporis callosi ic isthmus cinguli po sulcus parieto-occipitalis rsm ramus supramarginalis sulci cinguli s splenium corporis corporis callosi srp sulcus rostralis superior ssp sulcus subparietalis th mediodorsal thalamus th cuneus caud tf parasagittal @ gangliothalamic egg sr pul VA put vf cing sulcus cinguli ctg caudothalamic groove gc glomus choroideum rsm ramus supramarginalis sulci cinguli sr sulcus rhinalis tf transverse fissure (Bichat) VA ventral anterior thalamus vf ventral forebrain VL ventrolateral thalamus in the plane through the uncus, the deep grey matter nuclei forming the gangliothalamic egg can be recognised pall uncus VL pole sci circ sulcus circularis insulae ga gyrus accessorius insulae gb gyri breves: anterior, middle, posterior gl gyri longi lf lateral fissure sc sulcus centralis (cerebri) sci sulcus centralis insulae ga the insular triangle is contained by the sulcus circularis insulate (anterior, superior, inferior and posterior); the posterior long gyri are behind the sulcus centralis insulae, the anterior short gyri can be completed in front by a gyrus accessorius insulae; the gyri breves converge on the insular pole, posterior to the limen insulae (piriform cortex lateral to the lateral olfactory stria) gl gb circ parasagittal @ insula of Reil limen PT ra f1 pci the frontal lobe has two parts: gyrus precentralis is in front of sulcus centralis, the other frontal areas are in front of the sulci precentrales; frontal sulci subdivide the frontal lobe in a superior, middle and inferior frontal gyrus; the latter contains Broca’s area around the ramus ascendens of the lateral fissure f2 f1,2 sulci frontales (superior, medius) pci sulcus precentralis inferior pcs sulcus precentralis superior pot sulcus postcentralis PT pars triangularis (Broca area) ra ramus ascendens fissurae lateralis sc sulcus centralis (cerebri) parasagittal @ frontal and cerebral sulci how does the brain function ? c sulcus precentralis medialis calc sulcus calcarinus cing sulcus cinguli  f1 sulcus frontalis superior f2 sulcus frontalis medius f3 sulcus frontalis inferior fl ramus posterior fissurae lateralis fm sulcus frontomarginalis (Wernicke)  LL limbic lobe pci sulcus precentralis inferior  pcm sulcus precentralis medius pcs sulcus precentralis superior  po sulcus parieto-occipitalis poc sulcus postcentralis PT pars triangularis r sulcus centralis (Rolando) ra ramus ascendens fissurae lateralis rh ramus horizontalis fissurae lateralis rsm ramus supramarginalis sulci cinguli sang sulcus angularis scoll sulcus collateralis primary sulci: scheme sd sulcus diagonalis  sip sulcus intraparietalis  sl sulcus lunatus soa sulcus occipitalis anterior soi sulcus occipitalis inferior sot sulcus occipito-temporalis spa sulcus paracentralis sr sulcus rhinalis sri sulcus rostralis inferior srs sulcus rostralis superior ssp sulcus subparietalis st sulcus occipitalis transversus (Ecker) sts sulcus temporalis superior sti sulcus temporalis inferior 1 gyrus parahippocampalis 2 gyrus fusiformis 3 gyrus lingualis 4 lobulus paracentralis 5 precuneus 6 cuneus 7 gyrus supramarginalis 8 gyrus angularis pons pulvinar SSS calc sulcus calcarinus po sulcus parieto-occipitalis s splenium SSS sinus sagittalis superior the posterior fontanel window looks at sulcus parieto-occipitalis and cuneus, including splenium and the vascular tangle in the cavum veli interpositi and cisterna quadrigemina; this is also the windom where a linear probe provides full display of the superior sagittal sinus and its Willis’ cords; vermis cerebelli is often also well depicted mastoid views offer inspection of the transverse sinus, cerebellar hemispheres and vermis, pons, plus the outlet foramina of the fourth ventricle (with Blake’s pouch remnants in many preterms); with high frequency probes details ot the hippocampus can also be seen TS transverse sinus V4 fourth ventricle mastoid fontanel TS ac aqueductus cerebri ca cornu Ammonis th temporal horn ca scoll foliation ac mesencephalon temporosquamosal window above the auricula many preterms have an accessible window above the temporal squame; white matter of the temporal lobe and hippocampus can be visualised in part; often clear views of mesencephalon and pons are present, including the aqueduct foramen magnum (nuchal) window courtesy dr Mühlbacher, Zürich in small preterm infants there is good access to the posterior fossa from the nuchal window, especially in coronal planes with high resolution probes; sigmoid sinus and PICA can be visualised from this angle; especially details of cerebellar structure and abnormalities in the cisterna magna can be depicted in detail cm cisterna magna scoll sulcus collateralis regional structures Brodmann area although many sulci do not follow cytoarchitectonic patterns, to therefore conclude that the shape and location of sulci is of little relevance, is wrong for many good reasons: - plenty of sulci do correspond to a border between functional entities - the central groove does separate the motor brain from the other parts - the sulci and lobules of the left inferior frontal gyrus do differ from the right because they are special in language operations - development of sulci does correlate with a regression of the olfactory dominance and a progression of the visual dominance in the mammalian neocortex - the complexity of the insula in phylogenetics does relate to the more elaborate “awareness” in the human (and some other) species - the lateral fissure is not a sulcus, neither are the transverse and interhemispheric fissure - cortex between sulcus cinguli and corpus callosum is the output area of the limbic system - the pericentral area, with connections to the brainstem and spinal cord, is vulnerable to injury in newborns, in itself and due to subjacent white matter lesions - gyrus temporalis superior is crucial in language processsing annectant gyri cross sulci at specific sites, not in disorder … references, approach of the topic Although apparently counter-intuitive to the body of “knowledge” about sulci, gyri, lobes and regional cortical activity, the question remains appropriate. On the one hand there is the certainty that consciousness (even we ever define what it is) is poor or absent without cortex and thalamus, on the other it is still not possible for many brain functions to delineate the parts of the brain (and cortex) involved in it. Memory may be organised (encoded and registered) by entorhinal cortex and hippocampus, but memory engrams are all over the brain (surface). Sensory perception of the body may occur in the postcentral gyrus, but lesions there can be followed by extra-ordinary plasticity and recovery of function. … Neither gross anatomy, nor histology and histochemistry, nor animal experiments, nor PET scan, nor fMRI have been able to describe how specific actions really operate.Images based on neurovascular coupling, like the bold signal in fMRI, are at best very crude surrogates of function. The same goes for EEG and derivatives. This is because of the daunting complexity of the circuits in our brain. Every neuron is in fact a microcomputer and billions of them all work together with nuance (modulation). Although one knows that some neurons in the fusiform gyrus are specialised in face recognition, this does not mean that they are “the tool” for face recognition. They are merely part of a complex circuitry with parallel and hierarchical pathways, with feed forward and backward communications, in itself integrated with networks for other functions, e.g. linking the perceived face to the sound it makes.  On the other hand, as neonatologists, we all know that devastating brain damage as with asphyxia, leukomalacia, extensive focal infarction and other entities, is followed by profound weakening of the cognitive and motor repertoire. We also realised that subtle lesions, even just being born prematurely, changes the brain. This means that some structures, cells, tracts, are essential from early on in life and are best not damaged after a certain postmenstrual age. You cannot grow a new corticospinal tract or a long association tract in preterm infants at viable age, that process has occurred in utero. Subplate, with functions and fragilities, is a transient structure, no longer operating after about 34 w PMA. The neocortex is only formed once. Although neuronal precursors persist in hippocampus, repair after birth by neurogenesis in the central nervous system, is at best very limited. Cranial ultrasound uses a window in lifetime where direct access to structure is available because of the presence of fontanels. Many small preterm infants have rather large fontanels. Ultrasound vendors - rarely focusing on neonatal brain work - did provide probes with a round scanhead, so that major portions of the cranial content can be observed. Ultrasound, with no real documented side effects when used wisely as we do in clinical practice, can be performed bedside, with very limited disturbance to the infant, without pain. Above all it can be done serially at acceptable cost. There is no other tool that is practical to study the brain surface of one infant for weeks on end, every week, without harm.  introduction The cerebrum can be seen as a collection of four lobes (Gratiolet), in itself forming an outer neocortical circle around the middle ring of the cingulum, amygdala and insula, in themselves concentrated around the hippocampus and hypothalamus.  The first sulci to emerge are the sulcus hippocampi between archi- and paleocortex (the latter covering gyrus parahippocampalis), and the sulcus rhinalis between paleocortex (hippocampal and piriform) and neocortex. Two pericentral gyri stand vertically between the transversely oriented frontal, parietal and temporal gyri.  Gyri should not just be seen as structures between sulci, as many sulci, in their hidden deeper parts, harbor annectant (transverse or opposing) gyri that form bridges between the gyri. Some surface furrows are just the top of such annectant gyri. To identify sulci, and consequently gyri, the characterization of a given sulcus does not necessarily imply that it is composed of a single continuous space (Ribas 2010). A sulcus can consist of several parts, long or short, isolated or connected to other sulci. The parieto-occipital sulcus forms as a consequence of the appearance of the he posterior most portion of the corpus callosum, which results in the invagination of the medial surface and the consequent creation of that sulcus. Sulci have been divided into 4 types: limiting, axial, opercular, and complete:- limiting sulci separate functionally different areas (e.g. the central sulcus, which separates the motor and sensory area);- axial sulci develop along the axis of a functionally homogeneous area, as in the case of the posterior portion of the calcarine fissure, which is actually a fold situated in the center of the striate visual cortex;- opercular sulci are situated between cortical areas that are structurally and functionally different, but the separations exist only along their edges and not in their fundi (e.g. the lunate sulcus, which, when present, is oriented vertically, separating the striate from peristriate areas of the surface and including the submerged parastriate area within its walls);- complete sulci are those whose fundi produce rises in the walls of the lateral ventricles (e.g. the collateral sulcus creates the collateral eminence on the floor of the inferior horn, and the calcarine fissure causes the calcar avis in the medial wall of the posterior horn). Gratiolet LP: Memoire Sur Les Plis Cerébraux de L’homme et des Primates. Paris: Bertrand, 1854 Ribas G (2010) The cerebral sulci and gyri. Neurosurg Focus 28(2): 1-24. the human brain without gyri at 20w PMA examples Unable to display PDF file. Download instead. Mac OS X  2:lATTRløtøcom.apple.TextEncodingHcom.apple.maclO com.apple.provenanceZcom.apple.quarantineutf-8;134217984@â¥�,’E–—/Z‹kñÂ.Im0ÖWq/0081;00000000;; examples examples Unable to display PDF file. Download instead. Mac OS X  2Û ATTR Ü1Ücom.apple.TextEncodingë com.apple.provenanceöcom.apple.quarantineutf-8;134217984Â.Im0ÖWq/0082;69972c5d;Hype4;