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Salsi G, Volpe G, Montaguti E, Fanelli T, Toni F, Maffei M, Votino C, Pompilii E, Pilu G, Volpe P. Isolated Upward Rotation of the Fetal Cerebellar Vermis (Blake's Pouch Cyst) Is a Normal Variant: An Analysis of 111 Cases. Fetal Diagn Ther 2021; 48:485-492. [PMID: 34182549 DOI: 10.1159/000516807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of the study was to provide more detailed data about fetal isolated upward rotation of the cerebellar vermis rotation (Blake's pouch cyst) in particular regarding pregnancy outcome. METHODS This is a retrospective study of all cases of fetal isolated upward rotation of the cerebellar vermis (URCV) diagnosed in 3 referral centers in Italy from January 2009 to November 2019. Whenever possible, prenatal magnetic resonance imaging (MRI) was performed and a fetal karyotype was obtained. A detailed follow-up was obtained by consultation of medical records, interview with the parents, and the pediatricians. RESULTS Our study population included 111 patients with a prenatal diagnosis of isolated URCV made at a median gestational age of 21 weeks +3 days (interquartile range (IQR) 21 + 0-22 + 2). The median brain stem-vermis (BV) angle was 27° (IQR 24-29°). In 37.9% of the cases, a regression of the finding with restoration of normal anatomy was noted at a follow-up scan or at postnatal checks. A BV angle of 25° or less predicted regression with a probability in excess of 90%. MRI was performed in utero or at birth in 101 patients and always confirmed sonographic diagnosis. Fetal CGH array and/or karyotype was available in 97 cases and was always normal, but in 1 case. A postnatal follow-up was available in 102 infants (mean 7 months, range 0-10 years of age) and documented a normal neurologic development in all the cases. CONCLUSIONS Isolated URCV is most likely a normal variant of fetal anatomy without clinical consequences, at least at an early follow-up. A BV angle of 25° or less predicts intrauterine regression of the finding, but the outcome is good in all the cases. When a confident sonographic diagnosis is made, MRI is not mandatory. The risk of a chromosomal anomaly in these cases is probably low.
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Affiliation(s)
- Ginevra Salsi
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy
| | - Grazia Volpe
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST, Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Elisa Montaguti
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy
| | - Tiziana Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UDC Neuroradiologia, Bologna, Italy
| | - Monica Maffei
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UDC Neuroradiologia, Bologna, Italy
| | - Carmela Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Eva Pompilii
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy.,Gynepro Medical, Bologna, Italy
| | - Gianluigi Pilu
- Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna, Bologna, Italy
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
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Spinelli M, Wiest R, Di Meglio L, Baumann M, Raio L, Surbek D. The "vermian-crest angle": does it allow accurate categorisation of fetal upward rotation of cerebellar vermis on intrauterine MRI? A pilot study. Clin Radiol 2019; 74:489.e1-489.e7. [PMID: 30954236 DOI: 10.1016/j.crad.2019.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
AIM To test a new parameter to assess the position of the fetal cerebellar vermis in the posterior fossa (PF) using intrauterine magnetic resonance imaging (MRI). MATERIALS AND METHODS The angle between the cerebellar vermis and the internal occipital crest (vermian-crest angle, VCA) was assessed retrospectively using MRI in fetuses with and without PF anomalies. Spearman's rank test was used to investigate correlation of the VCA with gestational age (GA). Groups were compared using Student's t-test and the one-way analysis of variance (ANOVA) with the Bonferroni adjustment. Box-and-whisker plots were also used. RESULTS One hundred and two normal cases were identified. Mean±SD GA at MRI was 26.5±2.8 weeks (range: 22-32 weeks). The VCA was 64.49±11.5° independently of GA (r=0.19; p=0.12). In addition, 30 fetuses at 19-28 weeks were identified with Blake's pouch cyst (BPC; n=5), Dandy-Walker malformation (DWM; n=12), mega cisterna magna (MCM; n=10), and vermian hypoplasia (VH; n=3). The VCA was significantly different in the DWM (p<0.001) and BPC (p<0.001) subgroups, but was not significantly different in cases of VH (p=0.84) and MCM (p=0.95) in comparison with controls. CONCLUSIONS A new method to assess vermian position within the PF using intrauterine MRI was assessed. In combination with the other existing parameters, it may be helpful for addressing the categorisation of upward rotation of the fetal cerebellar vermis; however, further studies are necessary to strengthen the present findings.
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Affiliation(s)
- M Spinelli
- Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - R Wiest
- Department of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - L Di Meglio
- Private Centre "Diagnostica ecografica Aniello Di Meglio srl", Naples, Italy
| | - M Baumann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - L Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - D Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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Spinelli M, Di Meglio L, Mosimann B, Di Naro E, Surbek D, Raio L. The Vermian-Crest Angle: A New Method to Assess Fetal Vermis Position within the Posterior Fossa Using 3-Dimensional Multiplanar Sonography. Fetal Diagn Ther 2018; 46:223-230. [PMID: 30517923 DOI: 10.1159/000494721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal morphometry of the vermis and its relation to the posterior fossa (PF) rule out most major anomalies of the cerebellum. However, accurate categorization of the position and size of the fetal vermis remains a challenge. OBJECTIVE Our aim was to test a new method to assess the position and size of fetal vermis on 3-dimensional ultrasound (3D-US). METHODS We measured the vermian-crest angle (VCA) in normal fetuses using multiplanar 3D-US. We also assessed the diameters (superoinferior, anteroposterior, and horizontal) and volume of the vermis. The Spearman rank test and linear and polynomial regression analyses were used for statistical purposes. RESULTS We included 126 fetuses. Mean ± SD gestational age (GA) was 26.3 ± 4.6 (range 17-35.5) weeks. Mean ± SD superoinferior, anteroposterior, and horizontal diameters were 16.2 ± 4.9, 11.2 ± 3.6, and 5.6 ± 1.6 mm, respectively. Median (range) vermian volume was 0.50 (0.05-2.9) cm3. The VCA was 64.49° ± 11.45. We found no correlation between GA and VCA (r = 0.15; p = 0.13), a linear correlation between GA and vermian diameters, and a quadratic correlation between GA and vermian volume. CONCLUSIONS We provide a new method to assess vermian position and size within the PF using 3D-US. The combined information may be of value for screening purposes, particularly to differentiate between the various pathological situations encountered within the PF.
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Affiliation(s)
- Marialuigia Spinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy, .,Department of Clinical Research, University of Bern, Bern, Switzerland,
| | - Lavinia Di Meglio
- Private Centre "Diagnostica Ecografica Prenatale Aniello Di Meglio srl", Naples, Italy
| | - Beatrice Mosimann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Edoardo Di Naro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.,Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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Massoud M, Guibaud L. Prenatal imaging of posterior fossa disorders. A review. Eur J Paediatr Neurol 2018; 22:972-988. [PMID: 30143392 DOI: 10.1016/j.ejpn.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/23/2022]
Abstract
With advances in fetal imaging, prenatal diagnosis of posterior fossa anomalies has been greatly improved. Based on the anatomical approach proposed by Guibaud and Desportes in 2006, the main anomalies depicted according to the algorithm includes: (1) increased "fluid-filled" space of the posterior fossa, (2) abnormal biometry of the cerebellum, and (3) abnormal cerebellar anatomy. In this review, the spectrum of PF anomalies is covered in an attempt to update this approach in the light of both our experience, more than a decade since this algorithm was published, and the latest data in the literature.
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Affiliation(s)
- Mona Massoud
- Fetal Medicine Unit, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron, 69500, Lyon, France
| | - Laurent Guibaud
- Fetal Medicine Unit, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron, 69500, Lyon, France; Department of Pediatric and Fetal Imaging, Centre de Compétence des Malformations et Maladies congénitales du cervelet, Université Claude Bernard Lyon 1, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron, 69500, Lyon, France.
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Xie JX, You JH, Chen XK, Su YM, Liu JR, Su SS, Hou M, Lv GR. Three-dimensional sonographic minute structure analysis of fetal cerebellar vermis development and malformations: utilizing volume contrast imaging. J Med Ultrason (2001) 2018; 46:113-122. [PMID: 30291575 DOI: 10.1007/s10396-018-0906-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To obtain three-dimensional ultrasonic (3D US) structural details and biometrics of the fetal cerebellar vermis and evaluate the value of developmental and malformation identification. METHODS The 3D US minute structure of the fetal cerebellar vermis in mid-sagittal view was detected in normal fetuses (n = 438; 16-41 weeks). Biometric sizes were measured to establish the stage-specific norms and reproducibility analysis. Additionally, 28 fetuses with suspected abnormal posterior fossa contents were assessed to analyze the clinical value. RESULTS The minute structure of normal fetuses, including cerebellar vermis contours and the fastigial recess of the fourth ventricle, were visible around Week 19. The main lobules and fissures were apparent around Week 22, and all nine lobules, fissures, and the fourth ventricle were clearly displayed by Week 28. Cerebellar vermis biometric sizes (anterior-posterior length, cranio-caudal length, circumference, and surface area (SA)) grew in a linear fashion with high reliability, especially SA measurements (for intraclass, ICC 0.989, 95% CI (0.980-0.994); for interclass, ICC 0.992, 95% CI (0.984-0.996)). On the middle sagittal section of 3D US, the SA reduced at least 50% in the Dandy-Walker group with no recognizable cerebellar vermis structures showing. The SA in vermian hypoplasia malformation reduced during [Formula: see text] to 50% with the primary/secondary fissures absent or partly absent and arborization of the lobules reduced. That would be an important diagnosis and antidiastole clue. Combined with minute structural observation, sonographic diagnoses were accurate in 88% of cases. CONCLUSION Minute structures obtained by 3D US were clinically useful in the evaluation of cerebellar vermis development and cerebellar vermis malformations.
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Affiliation(s)
- Jing-Xian Xie
- Department of Obstetrics and Gynecology, Xiamen Maternity and Child Health Care Hospital, Xiamen, 361000, Fujian, People's Republic of China
| | - Jian-Hong You
- Department of Ultrasound, Zhongshan Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Xiao-Kang Chen
- Department of Ultrasound, Children's Hospital of Fudan University Xiamen Branch, Xiamen Children's Hospital, Xiamen, 361000, Fujian, People's Republic of China
| | - Yi-Ming Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Jin-Rong Liu
- Department of Ultrasound, Guangzhou Women and Children Medical Center, Guangzhou, 510000, People's Republic of China
| | - Shan-Shan Su
- Department of Ultrasound, The Second Clinical Medical College of Fujian Medical University, Quanzhou, 362000, Fujian, People's Republic of China
| | - Min Hou
- Department of Ultrasound, Affiliated Hospital of Hebei University, Baoding, 071000, People's Republic of China
| | - Guo-Rong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian, People's Republic of China.
- , Quanzhou, People's Republic of China.
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:28-37. [PMID: 26394557 DOI: 10.1002/uog.15755] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/10/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Diagnosis of isolated posterior fossa anomalies in children is biased by the fact that only those that are symptomatic are brought to the attention of the appropriate clinical personnel, and the reported rate is often affected by the adoption of different nomenclature, diagnostic criteria, outcome measures, duration of follow-up and neurodevelopmental tools. The aim of this systematic review was to explore the neurodevelopmental outcome of fetuses with a prenatal diagnosis of isolated posterior fossa anomalies. METHODS MEDLINE and EMBASE were searched electronically, utilizing combinations of the relevant medical subject heading terms for 'posterior fossa' and 'outcome'. Studies assessing the neurodevelopmental outcome in children with a prenatal diagnosis of isolated posterior fossa malformations were considered eligible. The posterior fossa anomalies analyzed included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). Two authors reviewed all abstracts independently. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Meta-analyses of proportions were used to combine data, and between-study heterogeneity was explored using the I(2) statistic. RESULTS A total of 1640 articles were identified; 95 were assessed for eligibility and a total of 16 studies were included in the systematic review. The overall rate of abnormal neurodevelopmental outcome in children with a prenatal diagnosis of DWM was 58.2% (95% CI, 21.8-90.0%) and varied from 0-100%. In those with a prenatal diagnosis of MCM, the rate of abnormal neurodevelopmental outcome was 13.8% (95% CI, 7.3-21.9%), with a range of 0-50%. There was no significant association between BPC and the occurrence of abnormal neurodevelopmental delay, with a rate of 4.7% (95% CI, 0.7-12.1%) and range of 0-5%. Although affected by the very small number of studies, there was a non-significant occurrence of abnormal neurodevelopmental delay in children with a prenatal diagnosis of VH, with a rate of 30.7% (95% CI, 0.6-79.1%) and range of 0-100%. CONCLUSIONS Fetuses diagnosed with isolated DWM are at high risk of abnormal neurodevelopmental outcome, while isolated MCM or BPC have a generally favorable outcome. The risk of abnormal developmental delay in cases with isolated VH needs to be further assessed. In view of the wide heterogeneity in study design, time of follow-up, neurodevelopmental tests used and the very small number of included cases, further future large prospective studies with standardized and objective protocols for diagnosis and follow-up are needed in order to ascertain the rate of abnormal neurodevelopmental outcome in children with isolated posterior fossa anomalies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hôpital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex 12, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal ultrasound imaging (part 1): nomenclature, diagnostic accuracy and associated anomalies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:690-7. [PMID: 25970099 DOI: 10.1002/uog.14900] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/07/2015] [Accepted: 04/17/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the outcome in fetuses with prenatal diagnosis of posterior fossa anomalies apparently isolated on ultrasound imaging. METHODS MEDLINE and EMBASE were searched electronically utilizing combinations of relevant medical subject headings for 'posterior fossa' and 'outcome'. The posterior fossa anomalies analyzed were Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). The outcomes observed were rate of chromosomal abnormalities, additional anomalies detected at prenatal magnetic resonance imaging (MRI), additional anomalies detected at postnatal imaging and concordance between prenatal and postnatal diagnoses. Only isolated cases of posterior fossa anomalies - defined as having no cerebral or extracerebral additional anomalies detected on ultrasound examination - were included in the analysis. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. We used meta-analyses of proportions to combine data and fixed- or random-effects models according to the heterogeneity of the results. RESULTS Twenty-two studies including 531 fetuses with posterior fossa anomalies were included in this systematic review. The prevalence of chromosomal abnormalities in fetuses with isolated DWM was 16.3% (95% CI, 8.7-25.7%). The prevalence of additional central nervous system (CNS) abnormalities that were missed at ultrasound examination and detected only at prenatal MRI was 13.7% (95% CI, 0.2-42.6%), and the prevalence of additional CNS anomalies that were missed at prenatal imaging and detected only after birth was 18.2% (95% CI, 6.2-34.6%). Prenatal diagnosis was not confirmed after birth in 28.2% (95% CI, 8.5-53.9%) of cases. MCM was not significantly associated with additional anomalies detected at prenatal MRI or detected after birth. Prenatal diagnosis was not confirmed postnatally in 7.1% (95% CI, 2.3-14.5%) of cases. The rate of chromosomal anomalies in fetuses with isolated BPC was 5.2% (95% CI, 0.9-12.7%) and there was no associated CNS anomaly detected at prenatal MRI or only after birth. Prenatal diagnosis of BPC was not confirmed after birth in 9.8% (95% CI, 2.9-20.1%) of cases. The rate of chromosomal anomalies in fetuses with isolated VH was 6.5% (95% CI, 0.8-17.1%) and there were no additional anomalies detected at prenatal MRI (0% (95% CI, 0.0-45.9%)). The proportions of cerebral anomalies detected only after birth was 14.2% (95% CI, 2.9-31.9%). Prenatal diagnosis was not confirmed after birth in 32.4% (95% CI, 18.3-48.4%) of cases. CONCLUSIONS DWM apparently isolated on ultrasound imaging is a condition with a high risk for chromosomal and associated structural anomalies. Isolated MCM and BPC have a low risk for aneuploidy or associated structural anomalies. The small number of cases with isolated VH prevents robust conclusions regarding their management from being drawn. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hôpital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex 12, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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Katorza E, Bertucci E, Perlman S, Taschini S, Ber R, Gilboa Y, Mazza V, Achiron R. Development of the Fetal Vermis: New Biometry Reference Data and Comparison of 3 Diagnostic Modalities-3D Ultrasound, 2D Ultrasound, and MR Imaging. AJNR Am J Neuroradiol 2016; 37:1359-66. [PMID: 27032974 DOI: 10.3174/ajnr.a4725] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Normal biometry of the fetal posterior fossa rules out most major anomalies of the cerebellum and vermis. Our aim was to provide new reference data of the fetal vermis in 4 biometric parameters by using 3 imaging modalities, 2D ultrasound, 3D ultrasound, and MR imaging, and to assess the relation among these modalities. MATERIALS AND METHODS A retrospective study was conducted between June 2011 and June 2013. Three different imaging modalities were used to measure vermis biometry: 2D ultrasound, 3D ultrasound, and MR imaging. The vermian parameters evaluated were the maximum superoinferior diameter, maximum anteroposterior diameter, the perimeter, and the surface area. Statistical analysis was performed to calculate centiles for gestational age and to assess the agreement among the 3 imaging modalities. RESULTS The number of fetuses in the study group was 193, 172, and 151 for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. The mean and median gestational ages were 29.1 weeks, 29.5 weeks (range, 21-35 weeks); 28.2 weeks, 29.05 weeks (range, 21-35 weeks); and 32.1 weeks, 32.6 weeks (range, 27-35 weeks) for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. In all 3 modalities, the biometric measurements of the vermis have shown a linear growth with gestational age. For all 4 biometric parameters, the lowest results were those measured by MR imaging, while the highest results were measured by 3D ultrasound. The inter- and intraobserver agreement was excellent for all measures and all imaging modalities. Limits of agreement were considered acceptable for clinical purposes for all parameters, with excellent or substantial agreement defined by the intraclass correlation coefficient. CONCLUSIONS Imaging technique-specific reference data should be used for the assessment of the fetal vermis in pregnancy.
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Affiliation(s)
- E Katorza
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - E Bertucci
- Prenatal Medicine Unit (E.B., S.T., V.M.), Department of Obstetrics and Gynecology, Modena Hospital, Modena, Italy
| | - S Perlman
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - S Taschini
- Prenatal Medicine Unit (E.B., S.T., V.M.), Department of Obstetrics and Gynecology, Modena Hospital, Modena, Italy
| | - R Ber
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Y Gilboa
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - V Mazza
- Prenatal Medicine Unit (E.B., S.T., V.M.), Department of Obstetrics and Gynecology, Modena Hospital, Modena, Italy
| | - R Achiron
- From the Antenatal Diagnostic Unit (E.K., S.P., R.B., Y.G., R.A.), Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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Meng X, Xie L. Quantitative evaluation of fetal brainstem-vermis and brainstem-tentorium angles by three-dimensional ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2076-2081. [PMID: 24996575 DOI: 10.1016/j.ultrasmedbio.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine reference values and ranges for brainstem-vermis (BV) angle and brainstem-tentorium (BT) angle and to assess the correlation among these angles, fetal gender and gestational age (GA) in 221 fetuses between 20 and 37 wk. The angles of the BV and BT were measured on the mid-sagittal view of the fetal head in normally developed Chinese fetuses. The ultrasound measurements, the fetal gender and the GA were collected for statistical analysis. Rank sum test revealed no significant differences in the measurements of the BV and the BT angles with respect to gender (all p > 0.05). Spearman rank correlation analysis showed no GA effect on the BV and the BT angles with correlation coefficients (r) of 0.05 (p > 0.05) and 0.09 (p > 0.05). The 95% reference ranges of the BV and the BT angles were 8.7° (4.5°-18.0°) and 28.0° (21.3°-43.8°), respectively. The newly established reference ranges may facilitate differential diagnosis of fetuses with suspected posterior fossa anomalies in the second and third trimesters.
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Affiliation(s)
- Xinyue Meng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Limei Xie
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
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Robinson AJ. Inferior vermian hypoplasia--preconception, misconception. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:123-136. [PMID: 24497418 DOI: 10.1002/uog.13296] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, 4480 Oak Street, Vancouver, V6H 3V4, Canada.
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Contro E, Volpe P, De Musso F, Muto B, Ghi T, De Robertis V, Pilu G. Open fourth ventricle prior to 20 weeks' gestation: a benign finding? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:154-158. [PMID: 24151160 DOI: 10.1002/uog.13227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/12/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the role of the brainstem-vermis (BV) angle in the diagnosis of fetal posterior fossa abnormalities at 15-18 weeks' gestation. METHODS We examined retrospectively three-dimensional (3D) ultrasound volumes acquired at 15-18 gestational weeks in fetuses with normal posterior fossa (controls) and in those with cystic posterior fossa. Whether the fourth ventricle appeared open posteriorly in axial views was noted and the BV angle was measured. A detailed follow-up was obtained in all cases. RESULTS Of the 139 controls, 46 cases were excluded because of inadequate quality of the 3D volumes. Of the 93 remaining normal fetuses, 84 (90.3%) had a closed fourth ventricle and a BV angle < 20°, whereas 9/93 (9.7%) had an open fourth ventricle and a BV angle between 20° and 37°. The study group of 11 fetuses included seven with Dandy-Walker malformation and four with Blake's pouch cyst. In abnormal cases as a whole, the BV angle was significantly increased compared with that in controls (P < 0.0001). However, fetuses with Blake's pouch cyst and normal fetuses with an open fourth ventricle had strikingly similar sonograms: the BV angle was between 20° and 37° and the fourth ventricle appeared open only when viewed using a more steeply angulated scanning plane than that of the standard transcerebellar plane; in fetuses with Dandy-Walker malformation the fourth ventricle was widely open posteriorly, even in the standard transcerebellar view, and the BV angle was > 45°, significantly increased compared both with that in normal fetuses (P < 0.0001) and with that in fetuses with Blake's pouch cyst (P = 0.004). CONCLUSION An open fourth ventricle is found in about 10% of normal fetuses at 15-18 weeks' gestation. Measurement of the BV angle is useful in such cases, as a value ≥ 45° is associated with a very high risk of severe posterior fossa malformation.
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Affiliation(s)
- E Contro
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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12
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A Case of Enlarged Intracranial Translucency in a Fetus with Blake's Pouch Cyst. Case Rep Obstet Gynecol 2014; 2014:968089. [PMID: 24523974 PMCID: PMC3912764 DOI: 10.1155/2014/968089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022] Open
Abstract
The intracranial translucency (IT) is a recently introduced marker of open spina bifida (OSB). In this study, we describe a case of a fetus affected by Blake's pouch cyst which showed alterations of BS/BSOB ratio at the first trimester screening.
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Ghali R, Reidy K, Fink AM, Palma-Dias R. Perinatal and short-term neonatal outcomes of posterior fossa anomalies. Fetal Diagn Ther 2013; 35:108-17. [PMID: 24217009 DOI: 10.1159/000355401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the perinatal and neonatal outcomes for fetuses with posterior fossa (PF) anomalies - mega-cisterna magna (MCM), persistent Blake's pouch (PBP) or the Dandy-Walker continuum (DWC) - using a new classification. METHODS 46 cases with PF anomaly diagnosed on ultrasound (US) between 16 and 28 weeks' gestation were included. The images were reviewed and classified as one of the following: MCM, PBP or DWC. Outcomes were obtained from patient records. RESULTS 30 cases with DWC, 6 with MCM, and 10 with PBP were identified. Associated anomalies were present in all groups, but more frequent in DWC. Agenesis of the corpus callosum and ventriculomegaly were more common in DWC than in MCM or PBP. Only fetuses with DWC were found to have chromosomal abnormalities. Perinatal outcomes differed significantly, with terminations of pregnancy more frequent in DWC. In the immediate postnatal period, infants with DWC had worse outcomes than those with MCM and PBP. Across all groups, those with associated anomalies had worse outcomes than those with an isolated PF anomaly. CONCLUSION Infants antenatally diagnosed with DWC had worse perinatal and short-term neonatal outcomes than those with MCM or PBP. Those with associated anomalies had uniformly poorer outcomes than those with isolated anomalies.
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Affiliation(s)
- Rim Ghali
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Araujo Júnior E, Passos AP, Bruns RF, Nardozza LMM, Moron AF. Reference range of fetal cisterna magna volume by three-dimensional ultrasonography using the VOCAL method. J Matern Fetal Neonatal Med 2013; 27:1023-8. [DOI: 10.3109/14767058.2013.847419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brusius CV, Cavalheiro S. Endoscopic third ventriculostomy is a safe and effective procedure for the treatment of Blake's pouch cyst. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:545-8. [DOI: 10.1590/0004-282x20130086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/04/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Blake's pouch cyst (BPC) is a midline cystic malformation of the posterior fossa, within Dandy-Walker's complex (DWC), often associated with hydrocephalus. Endoscopic third ventriculostomy (ETV) has been an alternative to conventional methods for BPC treatment. This study aimed at reporting our experience with ETV in a series of patients with BPC. METHODS: Of 33 patients diagnosed with midline posterior fossa cyst, 26 met the protocol criteria for DWC, and eight subjects with BPC were selected (aged one month to two years old). All cases were treated with ETV. RESULTS: Five patients were male; and three were prenatally diagnosed. They had hydrocephalus and motor deficiencies. Motor assessment at a five-year follow-up yielded normal findings. All patients improved, and only one had residual cognitive dysfunction, despite overall neurological improvement. There were no complications. CONCLUSIONS: ETV was a safe and effective procedure, reducing risks and morbidity associated with open surgery and shunt-related problems.
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Affiliation(s)
- Carlos Vicente Brusius
- Universidade Federal de Sao Paulo, Brazil; Hospital da Crianca Santo Antonio; Hospital Moinhos de Vento, Brasil
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Zhao D, Liu W, Cai A, Li J, Chen L, Wang B. Quantitative evaluation of the fetal cerebellar vermis using the median view on three-dimensional ultrasound. Prenat Diagn 2012; 33:153-7. [PMID: 23238967 DOI: 10.1002/pd.4027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness for quantitative evaluation of cerebellar vermis using three-dimensional (3D) ultrasound and to establish a nomogram for Chinese fetal vermis measurements during gestation. METHODS Sonographic examinations were performed in normal fetuses and in cases suspected of the diagnosis of vermian rotation. 3D median planes were obtained with both OMNIVIEW and tomographic ultrasound imaging. RESULTS Measurements of the cerebellar vermis were highly correlated between two-dimensional and 3D median planes. The diameter of the cerebellar vermis follows growth approximately predicted by the quadratic regression equation. The normal vermis was almost parallel to the brain stem, with the average angle degree to be <2° in normal fetuses. The average angle degree of the 9 cases of vermian rotation was >5°. CONCLUSIONS Three-dimensional median planes are obtained more easily than two-dimensional ones, and allow accurate measurements of the cerebellar vermis. The 3D approach may enable rapid assessment of fetal cerebral anatomy in standard examination. Measurements of cerebellar vermis may provide a quantitative index for prenatal diagnosis of posterior fossa malformations.
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Affiliation(s)
- Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Volpe P, Contro E, De Musso F, Ghi T, Farina A, Tempesta A, Volpe G, Rizzo N, Pilu G. Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:632-635. [PMID: 22253138 DOI: 10.1002/uog.11101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the role of the brainstem-vermis (BV) and brainstem-tentorium (BT) angles in the differential diagnosis of upward rotation of the fetal cerebellar vermis. METHODS The BV and BT angles were measured retrospectively on median sonographic views of the brain in 31 fetuses at 19-28 weeks' gestation with upward rotation of the cerebellar vermis due to Blake's pouch cyst (n = 12), Dandy-Walker malformation (n = 12) and cerebellar vermian hypoplasia (n = 7). Eighty normal fetuses at 20-24 weeks were included as controls. RESULTS In the control group, BV and BT angles were 9.1 ± 3.5° (range, 4-17°) and 29.3 ± 5.8° (range, 21-44°), respectively. The BV angle was significantly increased in each of the three subgroups of anomalies: Blake's pouch cyst (23 ± 2.8°; range, 19-26°), vermian hypoplasia (34.9 ± 5.4°; range, 24-40°) and Dandy-Walker malformation (63.5 ± 17.6°; range, 45-112°), the angle increasing with increasing severity of the condition. The BT angle had a similar pattern but there was overlap among the different groups. CONCLUSION The BV angle and, to a lesser degree, the BT angle are simple and reproducible measurements that provide valuable additional information for the categorization of upward rotation of the fetal cerebellar vermis. From mid gestation, a BV angle > 45° is strongly suggestive of a Dandy-Walker malformation, while a measurement < 30° favors the diagnosis of a Blake's pouch cyst.
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Affiliation(s)
- P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL Bari, Bari, Italy
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Gandolfi Colleoni G, Contro E, Carletti A, Ghi T, Campobasso G, Rembouskos G, Volpe G, Pilu G, Volpe P. Prenatal diagnosis and outcome of fetal posterior fossa fluid collections. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:625-631. [PMID: 22173885 DOI: 10.1002/uog.11071] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the accuracy of fetal imaging in differentiating between diagnoses involving posterior fossa fluid collections and to investigate the postnatal outcome of affected infants. METHODS This was a retrospective study of fetuses with posterior fossa fluid collections, carried out between 2001 and 2010 in two referral centers for prenatal diagnosis. All fetuses underwent multiplanar neurosonography. Parents were also offered fetal magnetic resonance imaging (MRI) and karyotyping. Prenatal diagnosis was compared with autopsy or postnatal MRI findings and detailed follow-up was attempted by consultation of medical records and interview with parents and pediatricians. RESULTS During the study period, 105 fetuses were examined, at a mean gestational age of 24 (range, 17-28) weeks. Sonographic diagnoses (Blake's pouch cyst, n = 32; megacisterna magna, n = 27; Dandy-Walker malformation, n = 26; vermian hypoplasia, n = 17; cerebellar hypoplasia, n = 2; arachnoid cyst, n = 1) were accurate in 88% of the 65 cases in which confirmation was possible. MRI proved more informative than ultrasound in only 1/51 cases. Anatomic anomalies and/or chromosomal aberrations were found in 43% of cases. Blake's pouch cysts and megacisterna magna underwent spontaneous resolution in utero in one third of cases and over 90% of survivors without associated anomalies had normal developmental outcome at 1-5 years. Isolated Dandy-Walker malformation and vermian hypoplasia were associated with normal developmental outcome in only 50% of cases. CONCLUSION Prenatal neurosonography and MRI are similarly accurate in the categorization of posterior fossa fluid collections from mid gestation. Blake's pouch cyst and megacisterna magna are risk factors for associated anomalies but when isolated have an excellent prognosis, with a high probability of intrauterine resolution and normal intellectual development in almost all cases. Conversely, Dandy-Walker malformation and vermian hypoplasia, even when they appear isolated antenatally, are associated with an abnormal outcome in half of cases.
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Affiliation(s)
- G Gandolfi Colleoni
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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Beni-Adani L. Neurofetal counseling for cerebellar and posterior fossa malformations--where do we stand today? Commentary on "the fetal cerebellum: development and common malformations" by Garel et al. J Child Neurol 2011; 26:1480-2. [PMID: 22114243 DOI: 10.1177/0883073811424800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bertucci E, Gindes L, Mazza V, Re C, Lerner-Geva L, Achiron R. Vermian biometric parameters in the normal and abnormal fetal posterior fossa: three-dimensional sonographic study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1403-1410. [PMID: 21968492 DOI: 10.7863/jum.2011.30.10.1403] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purposes of this study were to describe a 3-dimensional sonographic technique for evaluation of the fetal vermis and to compare vermian biometric parameters in fetuses with a normal and an abnormal posterior fossa. METHODS A prospective study was conducted from 2006 through 2008 on 12 fetuses with an abnormal posterior fossa and 73 healthy control fetuses from 18 to 35 weeks' gestation. Three-dimensional scans of the fetal head were performed in the axial plane, using static volume contrast imaging in the C-plane. The vermian perimeter, cross-sectional area, and superoinferior diameter were measured and compared between abnormal and normal fetuses using the Wilcoxon nonparametric test. Linear regression analysis was used to describe trends of the vermis during gestation. The z scores for perimeter, cross-sectional area, and superoinferior diameter measurements in the abnormal posterior fossa group in each 2-week interval were calculated. RESULTS Twelve fetuses with an abnormal posterior fossa were recruited: 3 with a Blake pouch cyst, 1 vermian cyst, 1 enlarged cisterna magna, 2 Dandy-Walker malformation, 4 partial vermian agenesis, and 1 hemicerebellar hypoplasia. The vermian cross-sectional area was reduced significantly in the fetuses with an abnormal posterior fossa compared with the control fetuses starting at 18 to 19 weeks' gestation (P = .01); the mean vermian superoinferior diameter was lower only from 22 to 23 weeks (P = .01); and the mean vermian perimeter was decreased from 28-29 weeks' gestation (P = .03). Linear regression analysis of the parameters showed that fetuses with an abnormal posterior fossa had a statistically significantly lower growth rate than control fetuses during gestation (P < .001). CONCLUSIONS Measurements of the cross-sectional area were more useful than those of the perimeter and superoinferior diameter in distinguishing between fetuses with a normal and an abnormal posterior fossa during the early stages of gestation.
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Affiliation(s)
- Emma Bertucci
- Prenatal Medicine Unit, Department of Obstetrics and Gynecology, Modena Hospital, Modena and Reggio Emilia University, Largo del Pozzo 71, 41123 Modena, Italy.
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Shen O, Yagel S, Valsky DV, Rabinowitz R, Zalel Y. Sonographic examination of the fetal vermis: tricks for obtaining the narrow midline target with 3-dimensional volume contrast imaging in the C plane. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:827-831. [PMID: 21632998 DOI: 10.7863/jum.2011.30.6.827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Prenatal imaging of the fetal cerebellar vermis is challenging even for experienced examiners. We found that by aiming the ultrasound beam through the mastoid fontanel and then rotating the data set in a multiplanar reconstruction and applying volume contrast imaging in the C plane, we were consistently able to obtain images of the vermis in the standard midsagittal plane. Images of the fetal vermis suitable for morphologic evaluation were obtained in 408 of 414 cases (98.5%) at gestational ages of 18 weeks to 31 weeks 6 days; the examination time was only minimally increased.
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Affiliation(s)
- Ori Shen
- Department of Obstetrics and Gynecology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel.
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Early fetal development of the human cerebellum. Surg Radiol Anat 2011; 33:523-30. [PMID: 21380713 DOI: 10.1007/s00276-011-0796-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
Early cerebellum development in humans is poorly understood. The present study histologically examined sections from 20 human embryos and fetuses at 6 weeks (12-16 mm crown-rump length (CRL); 4 specimens), 7-9 weeks (21-39 mm CRL; 8 specimens), 11-12 weeks (70-90 mm CRL; 4 specimens) and 15-16 weeks (110-130 mm CRL; 4 specimens). During 7-9 weeks (approximate CRL 28 mm), the rhombic lip (a pair of thickenings of the alar plate) protruded dorsally, bent laterally, extended ventrolaterally and fused with the medially located midbrain. During that process, the primitive choroid plexus appeared to become involved in the cerebellar hemisphere to form a centrally located eosinophilic matrix. At that stage, the inferior olive had already developed in the thick medulla. Thus, the term 'bulbo-pontine extension' may represent an erroneous labeling of a caudal part of the rhombic lip. The cerebellar vermis developed much later than the hemisphere possibly from a midline dark cell cluster near the aqueduct. In the midline area after 12 weeks (80 mm CRL), the growing bilateral hemispheres seem to provide mechanical stress such as rotation and shear that cause the development of several fissures much deeper than those on the hemisphere. The rapidly growing surface germinal layer may be a minor contributor to this vermian fissure formation. The vermian fissures seem to enable inside involvement of the surface germinal cells, and to induce cytodifferentiation of the vermis. Consequently, in the early stages, it appears that the cerebellar hemisphere and vermis develop independently of each other.
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Posterior fossa malformations: main features and limits in prenatal diagnosis. Pediatr Radiol 2010; 40:1038-45. [PMID: 20432023 DOI: 10.1007/s00247-010-1617-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 01/06/2010] [Indexed: 12/11/2022]
Abstract
Posterior fossa (PF) malformations are commonly observed during prenatal screening. Their understanding requires knowledge of the main steps of PF development and knowledge of normal patterns in US and MR imaging. The vast majority of PF malformations can be strongly suspected by acquiring a midline sagittal slice and a transverse slice and by systematically scrutinizing the elements of the PF: cerebellar vermis, hemispheres, brainstem, fourth ventricle, PF fluid spaces and tentorium. Analysis of cerebellar echogenicity and biometry is also useful. This review explains how to approach the diagnosis of the main PF malformations by performing these two slices and answering six key questions about the elements of the PF. The main imaging characteristics of PF malformations are also reviewed.
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Cornips EMJ, Overvliet GM, Weber JW, Postma AA, Hoeberigs CM, Baldewijns MMLL, Vles JSH. The clinical spectrum of Blake's pouch cyst: report of six illustrative cases. Childs Nerv Syst 2010; 26:1057-64. [PMID: 20198375 PMCID: PMC2903702 DOI: 10.1007/s00381-010-1085-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 01/20/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although Blake's pouch cyst (BPC) is frequently mentioned in the spectrum of posterior fossa cysts and cystlike malformations since its first description in 1996, its natural history, clinical presentation, specific imaging characteristics, optimal treatment, and outcome are relatively unknown. Consequently, BPC may still be underdiagnosed. We therefore report six cases ranging from a fatal hydrocephalus in a young boy, over an increasing head circumference with or without impaired neurological development in two infants, to a decompensating hydrocephalus at an advanced age. DISCUSSION We focus on their radiological uniformity, which should help making the correct diagnosis, and widely variable clinical presentation, which includes adult cases as well. Differentiating BPC from other posterior fossa cysts and cystlike malformations and recognizing the accompanying hydrocephalus are essentially noncommunicating, not only have important implications on clinical management but also on genetic counseling, which is unnecessary in case of BPC. In our experience, endoscopic third ventriculostomy is a safe and effective treatment option, avoiding the risks and added morbidity of open surgery, as well as many shunt-related problems.
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Affiliation(s)
- Erwin M. J. Cornips
- Department of Neurosurgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Geke M. Overvliet
- Department of Neurosurgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Jacobiene W. Weber
- Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A. Postma
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Johannes S. H. Vles
- Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
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Kapur RP, Mahony BS, Finch L, Siebert JR. Normal and abnormal anatomy of the cerebellar vermis in midgestational human fetuses. ACTA ACUST UNITED AC 2009; 85:700-9. [PMID: 19441098 DOI: 10.1002/bdra.20589] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation of the cerebellar vermis is an important component of fetal autopsy, but lack of an established approach, inadequate normal anatomic data, and the subtle nature of some cerebellar malformations negatively affect concordance between prenatal ultrasound and autopsy diagnoses. METHODS Gross anatomy and sagittal histologic sections of vermis from 26 midgestation fetuses with no posterior fossa anomalies detected by prenatal ultrasound or autopsy were examined to establish stage-specific norms. These were compared to data from three fetuses with prenatal ultrasound diagnoses of hypoplasia or absence of the cerebellar vermis, each of which had no or equivocal gross cerebellar malformation at autopsy. RESULTS Two findings segregated cases from controls: (1) The ratio of the rostro-caudal length of the vermis to that of the cerebellar hemispheres was shorter for cases (<0.7), in comparison with controls (0.7-1). (2) The lobules of the vermis, particularly in the posterior lobe, were less arborized, and the nodulus (caudal-most lobule) was elongated. Prenatal sonograms from the three cases predicted more severe vermis hypoplasia than was evident at autopsy. CONCLUSIONS Prenatal ultrasound images that suggest moderate-to-severe hypoplasia of the cerebellar vermis may reflect relatively subtle malformations, which are recognized histologically by direct comparison with stage-matched control data. The data in this series and others suggest a somewhat consistent pattern of lobular malformation, which affects the caudal cerebellum, particularly the nodulus, most severely. Rotation of the cerebellum, secondary to an enlarged fourth ventricle, may account for discordance between ultrasound and autopsy findings.
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Affiliation(s)
- Raj P Kapur
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington 98105, USA.
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Novakov-Mikić A, Koprivsek K, Lucić M, Belopavlović Z, Stojić S, Sekulić S. Prenatal diagnosis of posterior fossa anomalies--an overview. ACTA ACUST UNITED AC 2009; 62:157-63. [PMID: 19623847 DOI: 10.2298/mpns0904157n] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ultrasonography of the central nervous system is an integral part of a prenatal scan, and the development of imaging technologies has led to better diagnostic possibilities. Posterior fossa anomalies have traditionally been divided into Dandy Walke malformation, Dandy Walker variation and megacisterna magna, but this approach, due to diversity of the extensive number of possible disorders covered by this classification, unables accurate prognosis and therefore adequate counselling. An alternative approach to the classification of posterior fossa anomalies is to divide them into agenesis of the vermis, which could be partial or complete, cerebellar hypoplasia, pontocerebellar hypoplasia and cerebellar atrophy. Different ultrasonographic and magnetic resonance imagining of appearances of the posterior fossa anomalies in prenatal period are discussed in the article, as well as possible syndromes and prognosis of different entities. Diversity of anomalies of the central nervous system, and in particular, subtle differences in prenatal appearances of posterior fossa anomalies, which may have major impact on the prognosis, demand a multidisciplinary approach that encompasses two-dimensional and three-dimensional ultrasound scan, magnetic resonance imaging, infectious diseases and metabolic disorders work-ups as well as individual approach to every case involving of a team of experts in the field of perinatology, radiology, paediatrics, neurology and genetics.
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Malinger G, Lev D, Lerman-Sagie T. The fetal cerebellum. Pitfalls in diagnosis and management. Prenat Diagn 2009; 29:372-80. [DOI: 10.1002/pd.2196] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zalel Y, Yagel S, Achiron R, Kivilevich Z, Gindes L. Three-dimensional ultrasonography of the fetal vermis at 18 to 26 weeks' gestation: time of appearance of the primary fissure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1-8. [PMID: 19106349 DOI: 10.7863/jum.2009.28.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to establish the normality of the fetal vermis, ie, the time of appearance of the primary fissure, as well as its measurements between 18 and 26 weeks' gestation, using 3-dimensional (3D) ultrasonography. METHODS A prospective cross-sectional study of normal singleton pregnancies was conducted. Examinations were performed with high-resolution transabdominal ultrasonography using the axial plane in 173 fetuses between 18 and 26 weeks' gestation. Postprocessing measurements of the fetal vermis were done with 4-dimensional software using static volume contrast imaging and tomographic ultrasound imaging in the C-plane. Detection of the primary fissure was evaluated in all cases, and the time of appearance was documented. RESULTS Adequate vermis measurements were obtained in 173 fetuses. Vermian length as a function of gestational age was expressed by regression equations, and the correlation coefficients were found to be highly statistically significant (P < .001). The normal mean +/- 2 SD for each gestational week was defined. The primary fissure was observed at 24 weeks' gestation in all cases, at 22 weeks in 94% of cases, and as early as 18 weeks in 40%. CONCLUSIONS This 3D study documents the appearance of the primary fissure and presents the normal range of vermian measurements, confirming normal development of the fetal vermis starting as early as 18 weeks' gestation. It also shows an easy method for visualizing the vermis with 3D ultrasonography at every gestational week regardless of fetal presentation.
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Affiliation(s)
- Yaron Zalel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel.
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Robinson AJ, Blaser S, Toi A, Chitayat D, Halliday W, Pantazi S, Gundogan M, Laughlin S, Ryan G. The Fetal Cerebellar Vermis. Ultrasound Q 2007; 23:211-23. [PMID: 17805192 DOI: 10.1097/ruq.0b013e31814b162c] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fetal magnetic resonance provides a new tool in the imaging of the posterior fossa and is proving useful in cases that are difficult to assess sonographically by allowing further assessment of the fourth ventricle, cisterna magna, and vermian growth and development. We describe various criteria with which to evaluate vermian growth, including vermian biometry and the relationship between the superior and inferior lobes. We demonstrate 2 markers of normal vermian development: the primary fissure and fastigial point. We illustrate the tegmento-vermian angle, "closure" of the fourth ventricle, and communication of the fourth ventricle with the basal cisterns during development and in several disorders. We correlate those features with the expected embryological course of development and illustrate identification of these features and associated abnormalities of the posterior fossa, brain stem, and central nervous system in mid-trimester scans of fetuses with abnormal development. Correlation with contemporaneous ultrasound examinations is demonstrated.
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Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, Vancouver V6H 3V4, Canada.
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Viñals F, Muñoz M, Naveas R, Giuliano A. Transfrontal three-dimensional visualization of midline cerebral structures. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:162-8. [PMID: 17605149 DOI: 10.1002/uog.4073] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To compare sonographic visualization of midline cerebral structures obtained by two-dimensional (2D) imaging and three-dimensional (3D) multiplanar and volume contrast imaging in the coronal plane (VCI-C), with transfrontal 3D acquisition. METHODS Sixty consecutive healthy fetuses in vertex presentation at a mean gestational age of 24 (range, 20-33) weeks underwent 2D and 3D ultrasound examination. Sagittal cerebral planes were reconstructed using 3D acquisition from axial planes by multiplanar analysis and by VCI-C. The reconstructed midline images of both these techniques were compared with the midline structures visualized directly in the A-plane by transfrontal 3D acquisition using a sweep angle of 30 degrees . Measurement of the corpus callosum and cerebellar vermis and visualization of the fourth ventricle and the main vermian fissures were compared. The sharpness of the images was also assessed qualitatively. Mid-sagittal tomographic ultrasound imaging (TUI) was also performed. 3D planes were compared with 2D transfontanelle median planes obtained by transabdominal or, when required, transvaginal sonography. RESULTS The midline plane could be obtained in 88% of multiplanar, 82% of VCI-C and 87% of transfrontal analyses. Measurements of the corpus callosum and cerebellar vermis obtained by 3D median planes were highly correlated. The clearest and sharpest definition of midline structures was obtained with transfrontal acquisition. Primary and secondary fissures of the cerebellar vermis could be detected in 13-26% of multiplanar, 18-35% of VCI-C and 52-79% of transfrontal analyses. 2D visualization was superior or equal to the 3D transfrontal approach in all the parameters compared. CONCLUSION 3D planes obtained from axial acquisitions are simpler and easier to display than are transfrontal ones. However, artifacts and acoustic shadowing are frequent in 3D axial acquisition and spatial resolution is better in the direct visualization transfrontal technique. If the standard examination includes a view of the fetal facial profile, a quick 3D acquisition through the frontal sutures provides direct visualization for assessment of the midline structures. We believe that this volumetric methodology could represent a step towards incorporating a comprehensive fetal neuroscan into routine targeted organ evaluation.
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Affiliation(s)
- F Viñals
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Concepción, Chile.
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Zimmer EZ, Lowenstein L, Bronshtein M, Goldsher D, Aharon-Peretz J. Clinical significance of isolated mega cisterna magna. Arch Gynecol Obstet 2007; 276:487-90. [PMID: 17453222 DOI: 10.1007/s00404-007-0369-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 03/26/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The prevalence and clinical significance of isolated mega cisterna magna in both fetuses and adults is not yet well defined. It is therefore difficult to provide reliable parental counseling in cases of a fetal sonographic diagnosis of this anomaly. The aim of the present study was to, determine the cognitive profile of adults with isolated mega cisterna magna. METHODS We reviewed 19,301 consecutive CT/MRI of the brain. Isolated mega cisterna magna was observed in 49 cases. A battery of neuropsychological tests was performed in 18 adults with this anomaly and in 18 controls who had no brain anomaly on CT/MRI. RESULTS Subjects with isolated mega cisterna magna had a lower performance on memory tasks [RAVLT saving score (0.8 +/- 0.2 vs. 1.02 +/- 0.2, P = 0.003)] and verbal fluency [phonemic fluency (9.4 +/- 4.5 vs. 13.6 +/- 5.3, P = 0.02), semantic fluency (19.8 +/- 5.8 vs. 24.4 +/- 7.5, P = 0.05)]. They did not differ from controls in regard to the Raven similarity tests indicating that this brain anomaly is not associated with impairment of general cognitive abilities. CONCLUSION Adults with isolated mega cisterna have an overall normal cognitive functioning but may score inferior to controls on some parameters of memory and verbal fluency. Although application of adult cases to the fetuses is not well established, this information might be of value in parental counseling in cases of a fetus with this anomaly.
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Affiliation(s)
- Etan Z Zimmer
- Department of Obstetrics Gynecology, Rambam Medical Center, 31096 Haifa, Israel.
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Robinson AJ, Goldstein R. The cisterna magna septa: vestigial remnants of Blake's pouch and a potential new marker for normal development of the rhombencephalon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:83-95. [PMID: 17182713 DOI: 10.7863/jum.2007.26.1.83] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study was to show the normal sonographic embryologic anatomy of the cisterna magna septa, fourth ventricle, and cerebellar vallecula at various stages of development and our experience with their variable appearance in multiple planes and to discuss the probable relationship between the cisterna magna septa, Dandy-Walker continuum, mega cisterna magna, and persistent Blake's pouch. METHODS Retrospective and prospective selection of examples of cisterna magna septa was performed over approximately a 12-month period. Standard and nonstandard imaging planes were adopted as necessary. RESULTS The septa are typically seen inferoposterior to the cerebellar vermis, usually straight and parallel, arising at the cerebellovermian angle and coursing posteriorly to the occipital bone. The cisterna magna septa become contiguous with the roof of the fourth ventricle inferior to the cerebellar vermis. The cerebrospinal fluid space enclosed between the cisterna magna septa is in direct contiguity with the fourth ventricle via the vallecula and is always completely anechoic because it develops intra- and not extra-axially. CONCLUSIONS We propose that the cisterna magna septa represent the walls of Blake's pouch, a phylogenetic vestigial structure observed during ontogeny. Additionally, our observations support current opinion that a persistent Blake's pouch and mega cisterna magna represent (less severe) abnormalities within the Dandy-Walker continuum. The cisterna magna septa therefore are a marker of normal development of the roof of the rhombencephalon. Deviation from their normal appearances should prompt a closer assessment for associated abnormalities of the cerebellum, vermis, and brain stem by additional imaging in orthogonal planes with either sonography or magnetic resonance imaging.
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Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, 4480 Oak St, Vancouver, British Colombia, Canada.
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Guibaud L, des Portes V. Plea for an anatomical approach to abnormalities of the posterior fossa in prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:477-81. [PMID: 16619384 DOI: 10.1002/uog.2777] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- L Guibaud
- Department of Pediatric and Fetal Imaging, Hôpital Debrousse, Université Claude Bernard Lyon I, 29, Soeur Bouvier, 69322 Lyon Cedex 05, France.
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