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Updated: Dec 26, 2025
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
The fetal falx cerebelli
Matthew T Whitehead1,2, Gilbert Vezina3,4
1Department of Neuroradiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA. mwhitehe@childrensnational.org.
Background:
The falx cerebelli is a retrocerebellar dural reflection. The MR spectrum of the fetal falx cerebelli has not been described.
Objective:
To determine the prevalence of falx cerebelli abnormalities in the context of posterior fossa malformations and compare them to age-matched normal fetal MRI exams.
Materials And Methods:
We reviewed all consecutive fetal MRIs performed over 1 year at a children's hospital. We assessed the falx cerebelli in each examination for location, morphology, size and number. Exams were grouped into (1) normal or non-brain/head abnormalities or (2) abnormal brain or craniofacial structures. We used chi square, linear regression and logistic regression analyses; P<0.05 was considered significant.
Results:
We included 424 examinations (223 controls, 201 malformations) from 378 patients (mean gestational age 27±6 weeks). In the control group, the mean falx size was 2.6±1.2 mm (anteroposterior) × 11.0±3.2 mm (craniocaudal), with 80% retrovermian centered; the falx was linear (23%), Y-shape (15%), V-shape (22%) or U-shape (21%); it was unusually multiplicated (17%) or absent (<2%). Falx cerebellar abnormalities were more common in abnormal exams (59%; 119/201) than in normal exams (19%; 43/223) (P<0.001). The falx was abnormal with Blake pouch cysts (9/9, 100%) and rhombencephalosynapsis (3/4, 75%), absent in all Chiari II (n=9) and most Dandy-Walker malformations (5/6, 83%), commonly multiplicated in mega cisterna magna (14/22, 64%), and deviated or absent in cases with arachnoid cysts (3/3, 100%) and adhesions (4/5, 80%).
Conclusion:
Structural alterations of the falx cerebelli are more prevalent in fetuses with brain and craniofacial abnormalities. Specific changes offer clues to posterior fossa diagnoses.
Insights
Fetal MRI reveals falx cerebelli abnormalities are common in brain malformations. These changes in the falx cerebelli can help diagnose posterior fossa conditions.
Area of Science:
- Neuroimaging
- Fetal Medicine
- Developmental Biology
Background:
- The falx cerebelli, a dural reflection in the posterior fossa, has an undescribed MR spectrum in fetuses.
- Understanding its normal appearance and variations is crucial for diagnosing congenital abnormalities.
Purpose of the Study:
- To determine the prevalence of falx cerebelli abnormalities in fetuses with posterior fossa malformations.
- To compare these findings with age-matched normal fetal MRI exams.
Main Methods:
- Retrospective review of 424 fetal MRI examinations (223 controls, 201 malformations).
- Assessment of falx cerebelli location, morphology, size, and number.
- Statistical analysis including chi-square, linear, and logistic regression.
Main Results:
- Falx cerebelli abnormalities were significantly more common in fetuses with brain/craniofacial abnormalities (59%) compared to controls (19%).
- Specific abnormalities were associated with conditions like Blake pouch cysts, rhombencephalosynapsis, Chiari II, Dandy-Walker malformations, and arachnoid cysts.
Conclusions:
- Structural alterations of the falx cerebelli are prevalent in fetuses with brain and craniofacial abnormalities.
- Falx cerebelli changes provide valuable diagnostic clues for posterior fossa malformations.
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