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Agaoglu MO, Agaoglu Z, Ozturk FH, Celen S, Caglar T. Comparison of Cavum Septum Pellucidum Size in Euploid and Aneuploid Fetuses. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e511-e516. [PMID: 37846183 PMCID: PMC10579907 DOI: 10.1055/s-0043-1775847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/24/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE The aim of the present study is to compare the cavum septum pellucidi (CSP) z-score in euploid and aneuploid fetuses and to investigate the performance of the CSP width/length and CSP width/biparietal diameter (BPD) ratios as a diagnostic marker in aneuploidy. METHODS A total of 54 patients, 20 aneuploid and 35 euploid fetuses, between 18 and 37 weeks of gestation, were included in this retrospective study. The CSP width z-score was compared between the two groups. Receiver operating characteristic (ROC) curves were calculated for the CSP width/length and CSP width/BPD ratios to predict aneuploidy. RESULTS The median CSP width was 4.8 mm (range, 1.8 to 8.5 mm) in the euploid group, and 5.4 mm (range 3.1 to 8.4 mm) in the aneuploid group. Cavum septum pellucidi width z-score, CSP width/length ratio, and CSP width/BPD ratio were significantly higher in fetuses with aneuploidy than in fetuses with normal karyotype (p = 0.001; p = 0.013; p = 0.028). In the ROC analysis, the CSP width/length ratio had the optimal cutoff value of 0.59, with 72.0% sensitivity and 58.0% specificity, and for the CSP width/BPD ratio, the cutoff value was 0.081 with 83.0% sensitivity and 61.0% specificity for detection of aneuploidy. CONCLUSION CSP width z-score was found to be increased in aneuploid fetuses. The CSP width /BPD ratio can be used as a new marker for predicting aneuploidy.
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Affiliation(s)
- Merve Ozturk Agaoglu
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Zahid Agaoglu
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Filiz Halici Ozturk
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Sevki Celen
- Department of Perinatology, Etlik City Hospital, Ankara, Turkey.
| | - Turhan Caglar
- Department of Perinatology, Etlik City Hospital, Ankara, Turkey.
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Stanwell P, Iverson GL, Van Patten R, Castellani RJ, McCrory P, Gardner AJ. Examining for Cavum Septum Pellucidum and Ventricular Enlargement in Retired Elite-Level Rugby League Players. Front Neurol 2022; 13:817709. [PMID: 35493804 PMCID: PMC9044485 DOI: 10.3389/fneur.2022.817709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveA cavum septum pellucidum (CSP) has been reported as a visible brain anomaly in normal individuals as well in some former combat and collision sport athletes. The appearance of CSP with fenestrations and ventricular enlargement are considered associated features of the neuropathological diagnosis of chronic traumatic encephalopathy. The current study examined CSP anatomic features and lateral ventricle size in retired elite rugby league players and controls.MethodsForty-one retired rugby league players and 41 healthy community controls, similar in age and education, underwent structural MRI scans. CSP grade, CSP length, corpus callosum septal length, and Evans' ratio (for lateral ventricle size) were rated by two of the current study authors. All participants also self-reported concussion exposure histories, depressive symptoms, daytime sleepiness, and impulsivity. They completed a neuropsychological test battery assessing premorbid intellectual functioning, attention, processing speed, language, visuospatial skills, memory, and aspects of executive functioning.ResultsThe two raters had high agreement for CSP grade (Cohen's κ = 0.80), CSP length [intraclass correlation (ICC) = 0.99], corpus callosum septal length (ICC = 0.73), the CSP/septal ratio (ICC = 0.99), and the Evans' ratio (ICC = 0.75). Twenty-five retired players (61.0%) had an abnormal CSP compared to 17 controls [41.5%; χ(1, 82)2 = 3.12, p = 0.08, odds ratio = 2.21]. The CSP/septal ratio was larger for retired players than for the controls. The Evans' ratio did not differ between the two groups. In the retired rugby league players (n = 41), those with normal (n = 16) and abnormal (n = 25) CSP grades did not differ across age, age of first exposure to collision sport, years of sport exposure, concussion history, or 23 clinical and cognitive variables.ConclusionThis study revealed a difference in the size of the CSP between retired professional rugby league players and controls. There was no significant difference in the size of the ventricles between the two groups. There were no significant differences between those with vs. without an abnormal CSP on age of first exposure to rugby league, years of exposure to repetitive neurotrauma, number of lifetime concussions, depression, impulsivity, perceived cognitive decline, or on any neuropsychological test.
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Affiliation(s)
- Peter Stanwell
- Priority Research Centre for Stroke and Brain Injury, School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- *Correspondence: Peter Stanwell
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Providence Veterans Administration Medical Center, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Andrew J. Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Transitory and Vestigial Structures of the Developing Human Nervous System. Pediatr Neurol 2021; 123:86-101. [PMID: 34416613 DOI: 10.1016/j.pediatrneurol.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/23/2022]
Abstract
As with many body organs, the human central nervous system contains many structures and cavities that may have had functions in embryonic and fetal life but are vestigial or atrophic at maturity. Examples are the septum pellucidum, remnants of the lamina terminalis, Cajal-Retzius neurons, induseum griseum, habenula, and accessory olfactory bulb. Other structures are transitory in fetal or early postnatal life, disappearing from the mature brain. Examples are the neural crest, subpial granular glial layer of Brun over cerebral cortex, radial glial cells, and subplate zone of cerebral cortex. At times persistent fetal structures that do not regress may cause neurological problems or indicate a pathologic condition, such as Blake pouch cyst. Transitory structures thus can become vestigial. Examples are an excessively wide cavum septi pellucidi, suprapineal recess of the third ventricle, trigeminal artery of the posterior fossa circulation, and hyaloid ocular artery. Arrested maturation might be considered another aspect of vestigial structure. An example is the persistent microcolumnar cortical architecture in focal cortical dysplasia type Ia, in cortical zones of chronic fetal ischemia, and in some metabolic/genetic congenital encephalopathies. Some transitory structures in human brain are normal adult structures in lower vertebrates. Recognition of transitory and vestigial structures by fetal or postnatal neuroimaging and neuropathologically enables better understanding of cerebral ontogenesis and avoids misinterpretations.
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Kryukov EV, Stanishevsky AV, Gavrilov GV, Gizatullin SK. [Cysts of septum pellucidum, cavum vergae and cavum veli interpositi. Meta-analysis of 368 cases]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:111-118. [PMID: 32759934 DOI: 10.17116/neiro202084041111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review and systematize literature data on the incidence of cysts of septum pellucidum, cavum vergae and cavum veli interpositi, their clinical manifestations, indications for surgical treatment and optimal surgical approach. MATERIAL AND METHODS An analysis included 72 manuscripts devoted to epidemiology, pathophysiology, clinical symptoms and results of surgical treatment of brain cysts. Case reports, series of cases, reviews and original studies were analyzed. RESULTS Septum pellucidum cavity is always formed throughout an embryogenesis and persists in 20.34% of adults. Cavum vergae is observed in 2.32% of adults. Cyst of septum pellucidum is detected in 0.04% of adults. Analysis of 368 cases of cysts of septum pellucidum, cavum vergae and cavum veli interpositi has shown that clinical picture consists of headache (50% of cases), convulsive syndrome (23.6%), reduced intelligence (20.1%), behavioural disorders (15.8%), dizziness, nausea and vomiting (10.9%). Hydrocephalus occurs in 16.6% of cases. Endoscopic wall fenestration is preferred for cyst management. CONCLUSION Brain cysts are rare and characterized by non-specific clinical manifestations. Symptomatic cyst is an indication for surgical treatment. Surgical treatment usually ensures regression of symptoms and low risk of complications.
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Affiliation(s)
- E V Kryukov
- Burdenko Main Military Clinical Hospital, Moscow, Russia
| | | | - G V Gavrilov
- Kirov Military Medical Academy, St. Petersburg, Russia
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Otsuka Y, Chang L, Kawasaki Y, Wu D, Ceritoglu C, Oishi K, Ernst T, Miller M, Mori S, Oishi K. A Multi-Atlas Label Fusion Tool for Neonatal Brain MRI Parcellation and Quantification. J Neuroimaging 2019; 29:431-439. [PMID: 31037800 DOI: 10.1111/jon.12623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/12/2019] [Indexed: 01/01/2023] Open
Abstract
Structure-by-structure analysis, in which the brain magnetic resonance imaging (MRI) is parcellated based on its anatomical units, is widely used to investigate chronological changes in morphology or signal intensity during normal development, as well as to identify the alterations seen in various diseases or conditions. The multi-atlas label fusion (MALF) method is considered a highly accurate parcellation approach, and anticipated for clinical application to quantitatively evaluate early developmental processes. However, the current MALF methods, which are designed for neonatal brain segmentations, are not widely available. In this study, we developed a T1-weighted, neonatal, multi-atlas repository and integrated it into the MALF-based brain segmentation tools in the cloud-based platform, MRICloud. The cloud platform ensures users instant access to the advanced MALF tool for neonatal brains, with no software or installation requirements for the client. The Web platform by braingps.mricloud.org will eliminate the dependence on a particular operating system (eg, Windows, Macintosh, or Linux) and the requirement for high computational performance of the user's computers. The MALF-based, fully automated, image parcellation could achieve excellent agreement with manual parcellation, and the whole and regional brain volumes quantified through this method demonstrated developmental trajectories comparable to those from a previous publication. This solution will make the latest MALF tools readily available to users, with minimum barriers, and will expedite and accelerate advancements in developmental neuroscience research, neonatology, and pediatric neuroradiology.
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Affiliation(s)
- Yoshihisa Otsuka
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Neurology, Kobe University School of Medicine, Kobe, Japan
| | - Linda Chang
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.,Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD, USA
| | - Yukako Kawasaki
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Dan Wu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Can Ceritoglu
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA
| | - Kumiko Oishi
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Ernst
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.,Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD, USA
| | - Michael Miller
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA
| | - Susumu Mori
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ho YK, Turley M, Marc-Aurele KL, Jones MC, Housman E, Engelkemier D, Romine LE, Khanna PC, Pretorius DH. Enlarged Cavum Septi Pellucidi and Vergae in the Fetus: A Cause for Concern. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1657-1668. [PMID: 28417514 DOI: 10.7863/ultra.16.06081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/07/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate fetal cases identified at our institution to determine whether an enlarged cavum septi pellucidi or cavum vergae is associated with other fetal abnormalities and whether its presence warrants more detailed investigation of the fetus. METHODS In a retrospective study, 15 high- and low-risk patients undergoing prenatal sonography who had an enlarged cavum septi pellucidi or cavum vergae identified were reviewed. Data were collected for the sonographic study indication, gestation age at diagnosis of a prominent cavum, and associated anomalies. Follow-up outcome data regarding further imaging, karyotype, diagnosis of brain anomaly, and associated congenital abnormalities were obtained. RESULTS Fifteen patients met the inclusion criteria. Nine patients were identified as having a prominent cavum septi pellucidi, and 6 were identified as having a prominent cavum vergae. The mean gestational age ± SD was 22.7 ± 5.9 weeks. Eleven patients made it to delivery. Of the 15 patients, 4 were thought to have trisomy 21, and 13 had congenital anomalies. Outcomes included 10 major adverse outcomes, 4 cases with normal development or minor abnormalities, and 1 lost to follow-up. An isolated dilated cavum on prenatal sonography was seen in 5 cases: 1 with lissencephaly on a neonatal examination, 3 premature deliveries (1 demise, 1 hospice, and 1 normal), and 1 unknown. CONCLUSIONS Our cohort had many associated clinical anomalies: 3 confirmed trisomy 21 and 1 probable trisomy 21, 2 genetic disorders, and 10 major adverse outcomes, 5 of which were grave. Although we studied a small cohort, we conclude that an enlarged cavum septi pellucidi or cavum vergae warrants consideration of genetic counseling, which may include noninvasive prenatal testing (cell-free DNA), amniocentesis with microarray testing, or both.
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Affiliation(s)
- Yoona K Ho
- Maternal-Fetal Care and Genetics Center, University of California, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
| | - Michelle Turley
- Maternal-Fetal Care and Genetics Center, University of California, San Diego, California, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Marilyn C Jones
- Maternal-Fetal Care and Genetics Center, University of California, San Diego, California, USA
- Genetics, University of California, San Diego, California, USA
- Departments of Genetics, Rady Children's Hospital, San Diego, California, USA
| | - Elise Housman
- Departments of Radiology, University of California, San Diego, California, USA
| | | | - Lorene E Romine
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Dolores H Pretorius
- Maternal-Fetal Care and Genetics Center, University of California, San Diego, California, USA
- Departments of Radiology, University of California, San Diego, California, USA
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7
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Kaur C, Ling EA. Transitory cystic cavities in the developing mammalian brain - normal or anomalous? J Anat 2016; 230:197-202. [PMID: 27761896 DOI: 10.1111/joa.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/28/2022] Open
Abstract
Transitory cavities associated with the ventricular system represent probably one of the most unique features in the developing mammalian brain. In rodents, the cavities exist transiently in the developing brain and do not appear to be associated with any pathological events. Among the various cavities, the pyramidal-shaped cavum septum pellucidum (CSP) located beneath the corpus callosum and between the lateral ventricles is most well defined. In addition to the CSP are the bilateral subependymal cysts that are consistently associated with the third and fourth ventricles as well as the aqueduct. The cavities/cysts contain a large number of amoeboid microglia expressing surface receptors and hydrolytic enzymes common to tissue macrophages. The significance of these cavities in the developing brain remains a conjecture. Firstly, the cavity walls are free of an apparent epithelial lining; hence, it is speculated that the cavities that appear to communicate with the widened neighboring interstitial tissue spaces may have resulted from physical traction due to the rapid growth of the perinatal brain. Secondly, the cavities contain prominent clusters of amoeboid microglia that may be involved in clearing the debris of degenerating axons and cells resulting from the early brain tissue remodeling. With the increase in brain tissue compactness following the beginning of myelination in the second postnatal week, all cavities are obliterated; concomitantly, the number of amoeboid microglia in them diminishes and all this might signal further maturation of the brain.
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Affiliation(s)
- Charanjit Kaur
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eng-Ang Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Malinger G, Lev D, Oren M, Lerman-Sagie T. Non-visualization of the cavum septi pellucidi is not synonymous with agenesis of the corpus callosum. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:165-170. [PMID: 22689012 DOI: 10.1002/uog.11206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To describe a cohort of fetuses with non-visualization of the cavum septi pellucidi (CSP) without callosal agenesis and to assess the significance of this finding with respect to postnatal development. METHODS We reviewed the files of all patients referred because of suspected fetal supratentorial midline anomalies, and identified those fetuses with a diagnosis of non-visualization or obliteration of the CSP. RESULTS From an initial cohort of 114 patients we identified 23 cases. Mean ( ± SD) gestational age at referral was 24.5 ± 1.3 weeks; referral diagnoses (with more than one in some cases) included: non-visualization or an echogenic CSP (n = 18), suspected callosal anomaly (n = 5), other findings (n = 5). The fetuses were examined for the first time at the Fetal Neurology Clinic at a mean gestational age of 26.6 ± 3.1 weeks (range, 22-34 weeks; median, 27 weeks). In all of the fetuses the zone where fluid should have been observed was echogenic. In 17 fetuses this was an apparently isolated finding and in six it was associated with other findings, but only one fetus had associated malformations. Follow-up was available for 16 children at a mean age of 17.4 months (range, 4-36 months; median, 19.5 months). Normal development was reported in 14 children. One child had infantile hypotonia but normal developmental milestones and another had mild motor delay and language delay. These two children did not have associated anomalies at the prenatal scan. CONCLUSION Non-visualization of the CSP is not always associated with agenesis of the corpus callosum. When isolated it may be considered a variation of normal development.
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Affiliation(s)
- G Malinger
- Fetal Neurology Clinic, Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Hicdonmez T, Turan Suslu H, Butuc R, Bilal S, Akinci AT. Treatment of a large and symptomatic septum pellicidum cyst with endoscopic fenestration in a child--case report and review of the literature. Clin Neurol Neurosurg 2012; 114:1052-6. [PMID: 22503059 DOI: 10.1016/j.clineuro.2012.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 01/17/2012] [Accepted: 01/28/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Tufan Hicdonmez
- Trakya University Faculty of Medicine, Department of Neurosurgery, Edirne, Turkey; Dr Lutfi Kırdar Kartal Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
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Hagmann CF, Robertson NJ, Acolet D, Nyombi N, Ondo S, Nakakeeto M, Cowan FM. Cerebral measurements made using cranial ultrasound in term Ugandan newborns. Early Hum Dev 2011; 87:341-7. [PMID: 21353402 DOI: 10.1016/j.earlhumdev.2011.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few cUS studies of cerebral measurements are available for normal term infants. Normative data is important for evaluating cerebral structure size in symptomatic term infants and assessing preterm brain growth by term age. OBJECTIVES To (i) make linear measurements using cranial ultrasound (cUS) for major cerebral structures and intracranial spaces in normal newborn term infants, (ii) correlate these measurements with gestational age (GA), birth weight (BW), head circumference (HC), gender and within one infant (iii) examine inter/intra-observer variation, and (iv) compare these data with those currently available. DESIGN, SETTING AND PATIENTS Linear cUS measurements of major cerebral structures were made in well term-born Ugandan infants at Mulago University Hospital, Kampala. Correlations between the measurements and gender, HC, BW and GA were calculated. Intra- and inter-observer agreements were assessed. RESULTS Data from 106 infants (mean GA 39.20±1.4SD weeks) were analysed. Intra/inter-observer agreement was substantial/excellent. Significant correlations were found between HC and pons anterior-posterior diameter (p<0.01), corpus callosal (CC) length (p=0.02) and transverse cerebellar diameter (TCD, p<0.01) and between BW and CC length (p=0.02), vermis height (<0.01) and thalamo-occipital distance (p=0.03); no significant correlation was found with GA. Within infants CC length and TCD correlated significantly (p=0.019). Males had larger left ventricular indices than females (p=0.04). The data was similar to those from other populations. CONCLUSIONS These data provide reliable reference values for linear measurements of many cerebral structures made using cUS. The data agree well with those from other populations suggesting that cerebral size is similar in different ethnic groups.
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Affiliation(s)
- C F Hagmann
- EGA UCL Institute for Women's Health, UCL, UK
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Guillerman RP. Infant craniospinal ultrasonography: beyond hemorrhage and hydrocephalus. Semin Ultrasound CT MR 2010; 31:71-85. [PMID: 20304317 DOI: 10.1053/j.sult.2010.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography is widely used for screening for neonatal intracranial hemorrhage, hydrocephalus, and cord tethering in young infants. Proper interpretation of infant cranial and spinal ultrasound examinations requires not only familiarity with the appearances of these disorders, but also recognition of imaging artifacts capable of mimicking pathology and awareness of developmental variants and conditions that occupy a borderline position along the spectrum from normal to abnormal. This article will review the current understanding of the ultrasonographic characteristics and clinical relevance of these imaging artifacts, developmental variants, and quasi-pathologic conditions to avoid diagnostic pitfalls and guide appropriate patient management.
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Affiliation(s)
- R Paul Guillerman
- Department of Diagnostic Imaging, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
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13
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Imaging the corpus callosum, septum pellucidum and fornix in children: normal anatomy and variations of normality. Neuroradiology 2009; 51:337-45. [PMID: 19271214 DOI: 10.1007/s00234-009-0506-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
Abstract
The midline structures of the supra-tentorial brain are important landmarks for judging if the brain has formed correctly. In this article, we consider the normal appearances of the corpus callosum, septum pellucidum and fornix as shown on MR imaging in normal and near-normal states.
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14
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Pearce J. Some Observations on the Septum Pellucidum. Eur Neurol 2008; 59:332-4. [DOI: 10.1159/000121428] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/11/2007] [Indexed: 11/19/2022]
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Leijser LM, Srinivasan L, Rutherford MA, Counsell SJ, Allsop JM, Cowan FM. Structural linear measurements in the newborn brain: accuracy of cranial ultrasound compared to MRI. Pediatr Radiol 2007; 37:640-8. [PMID: 17486330 DOI: 10.1007/s00247-007-0485-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 03/02/2007] [Accepted: 03/03/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Structural size in the neonatal brain is of clinical importance. Cranial ultrasonography (cUS) is the primary method used for evaluating the neonatal brain and it is important to know whether linear measurements made using this technique are accurate. OBJECTIVE To compare linear measurements of different cerebral structures made from neonatal cUS and contemporaneous MRI. MATERIALS AND METHODS Preterm and term infants studies with cUS and MRI on the same day were studied. Linear measurements made using both techniques from many cerebral structures were compared using a paired t-test. RESULTS A total of 44 sets of scans from 26 preterm and 8 term infants were assessed. Small but significant differences between the cUS and MRI measurements (P<0.05) were found for the ventricular index, the posterior horn depth of the lateral ventricle, the extracerebral space and interhemispheric fissure, and the cortex of the cingulate gyrus. No significant differences were found for any other measurements. CONCLUSION Linear measurements from cUS are accurate for most neonatal cerebral structures. Significant differences compared to MRI were found for a few structures, but only for the cortex were the absolute differences marked and possibly of clinical importance.
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Affiliation(s)
- Lara M Leijser
- Department of Paediatrics, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 OHS, UK
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Weyerbrock A, Mainprize T, Rutka JT. Endoscopic fenestration of a symptomatic cavum septum pellucidum: technical case report. Neurosurgery 2007; 59:ONSE491; discussion ONSE491. [PMID: 17038961 DOI: 10.1227/01.neu.0000234051.86350.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cysts of the septum pellucidum (CSPs) may become symptomatic because of obstruction of cerebrospinal fluid flow, resulting in increased intracranial pressure and hydrocephalus requiring surgical intervention. Endoscopic fenestration may be the most effective and least invasive technique to treat this pathological condition. CLINICAL PRESENTATION An 11-year-old boy sought treatment for frequent episodes of severe headache. On examination, he had papilledema. There was evidence on magnetic resonance imaging scans of a space-occupying CSP with obstructive hydrocephalus. INTERVENTION The endoscopic technique of fenestration of both lateral walls of an enlarged CSP via a left frontal approach under ultrasound guidance using a rigid endoscope was successful. After surgery, the patient became asymptomatic, his papilledema resolved, and magnetic resonance imaging scans demonstrated collapse of the walls of the CSP toward the midline. CONCLUSION Neuroendoscopic fenestration should be strongly considered as the treatment of choice for symptomatic CSPs. This procedure alone can lead to complete resolution of clinical symptoms and hydrocephalus, can reduce the size of the CSP, and can obviate the need for an implantable cerebrospinal fluid shunt.
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Affiliation(s)
- Astrid Weyerbrock
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Brisch R, Bernstein HG, Krell D, Stauch R, Trübner K, Dobrowolny H, Kropf S, Bielau H, Bogerts B. Volumetric analysis of septal region in schizophrenia and affective disorder. Eur Arch Psychiatry Clin Neurosci 2007; 257:140-8. [PMID: 17180571 DOI: 10.1007/s00406-006-0697-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 08/28/2006] [Indexed: 10/23/2022]
Abstract
MRI and post-mortem studies indicate an increased prevalence of cavum septi pellucidi (CSP) in schizophrenia and affective disorder. The aim of this study was to characterize the CSP and the septal tissue among patients with schizophrenia, patients with affective disorder, and control subjects. The volumes of CSP and septal tissue were measured in post-mortem brains in 42 patients with schizophrenia, 14 patients with affective disorder, and 17 normal control cases by planimetry of serial sections. Enlargements of CSP (>100 mm(3)) were found in eight of the 42 (19%) patients with schizophrenia. There were no significant differences in CSP volumes between patients with affective disorder and controls. Enlarged CSP in schizophrenia were not associated with reduced septal tissue volumes. By contrast, a significant positive correlation between volumes of CSP and septal tissue volumes in patients with schizophrenia (P = 0.03) and in control cases (P < 0.01) was found, but not in patients with affective disorder (P = 0.53). The finding of enlarged CSP in schizophrenia strongly supports the hypothesis of an early developmental abnormality in this key structure of the limbic system.
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Affiliation(s)
- Ralf Brisch
- Dept. of Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
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Needelman H, Schroeder B, Sweeney M, Schmidt J, Bodensteiner JB, Schaefer GB. Postterm closure of the cavum septi pellucidi and developmental outcome in premature infants. J Child Neurol 2007; 22:314-6. [PMID: 17621502 DOI: 10.1177/0883073807300538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors report the natural history of closure of the cavum Septi pellucidi in premature infants 26 to 27 weeks postconception at birth and compare the developmental outcome in these infants who had closure by 42 weeks postconception to those who still had a cavum septum pellucidi visualized on ultrasound at approximately term (35-42 weeks). Of 72 patients, 35 patients still had a cavum septum pellucidi visualized on the last ultrasound done between 35 and 42 weeks postconception, and the developmental outcome of these patients was no different from those with earlier closure. The authors conclude that persistence of a cavum septi pellucidi through term is not an independent risk factor for developmental delay.
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Affiliation(s)
- Howard Needelman
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198-5440, USA.
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Dickey CC, McCarley RW, Xu ML, Seidman LJ, Voglmaier MM, Niznikiewicz MA, Connor E, Shenton ME. MRI abnormalities of the hippocampus and cavum septi pellucidi in females with schizotypal personality disorder. Schizophr Res 2007; 89:49-58. [PMID: 17027236 PMCID: PMC2777663 DOI: 10.1016/j.schres.2006.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 08/14/2006] [Accepted: 08/16/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study examined MRI hippocampal volume and cavum septi pellucidi (CSP) in female subjects with schizotypal personality disorder (SPD) and comparison subjects. METHOD MRI was performed on 20 SPD and 29 comparison subjects with delineation of left and right hippocampi. Number of slices containing the CSP was counted. Subjects were given a working memory task, the Delayed Alternation task and other measures of working memory including the Wechsler Memory Test-Revised and the California Verbal Learning Test. Clinical measures were derived from the SCID-II. RESULTS SPD females evinced bilaterally smaller hippocampal volumes compared with non-psychiatric female subjects (15.1% on left, 15.7% on right). Additionally, SPD subjects showed statistically significantly more slices containing CSP, and a trend level difference when large CSP was defined as four or more slices (20% vs. 6.9%). SPD subjects demonstrated more errors, more perseverations, and a trend toward more failure to maintain set on the Delayed Alternating task, which were associated with smaller left hippocampal volumes. There was no difference between groups in logical memory, verbal learning or semantic clustering nor a significant correlation between these measures and hippocampal volumes. Clinically, in SPD subjects, right hippocampal volumes correlated negatively with odd appearance/behavior and positively with suspiciousness/paranoia, and odd speech was positively correlated with the number of slices containing a CSP in exploratory analyses. CONCLUSIONS Female SPD subjects showed bilaterally smaller hippocampal volumes and larger CSP than comparison subjects, similar to what has been shown in schizophrenia. Moreover, these abnormalities have clinically significant associations which may help to explain some of the manifestations of the disorder.
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Affiliation(s)
- Chandlee C Dickey
- Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA.
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Sayama CM, Harnsberger HR, Couldwell WT. Spontaneous regression of a cystic cavum septum pellucidum. Acta Neurochir (Wien) 2006; 148:1209-11. [PMID: 16998663 DOI: 10.1007/s00701-006-0903-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 08/28/2006] [Indexed: 10/24/2022]
Abstract
A persistent cavum septum pellucidum (CSP) is present in approximately 0.73% of adults, although its incidence ranges from 0.14 to 18.9% depending on the detection method. Cystic CSP is even rarer. A cyst causing mass within the CSP can obstruct the intraventricular foramen, leading to blockage of CSF flow and possible hydrocephalus, often justifying surgical intervention. We describe spontaneous decompression of a cystic CSP in a 36-year-old man. Initial MRI showed a cystic CSP with lateral bowing of the septal walls to 1.9 cm. Follow-up MRI 15 months later demonstrated no lateral bowing, and the septal wall width was 1.0 cm. This spontaneous decompression was not explained by the one previously described case report of cystic CSP regression.
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Affiliation(s)
- C M Sayama
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA
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21
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Needelman H, Schroeder B, Sweney M, Schmidt J, Bodensteiner JB, Schaefer GB. Ontogeny and physiology of the cavum septum pellucidum in premature infants. J Child Neurol 2006; 21:298-300. [PMID: 16900925 DOI: 10.1177/08830738060210041501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the natural history of the closure of the cavum septum pellucidum in 47 premature infants. In this study, a cavum septum pellucidum was present in all patients at 25 to 26 weeks' postconceptual age, in keeping with previous reports. The data from this study suggest that premature delivery does not change the natural history of the normal closure of the cavum septum pellucidum in most infants by 36 to 40 weeks' postconceptual age. Although not statistically significant, there is a suggestion from these data that higher grades of intraventricular hemorrhage are more frequently associated with loss (early closure) of the cavum septum pellucidum. One particularly illustrative case with a grade 4 intraventricular hemorrhage and subsequent hydrocephalus suggests that increases in pressure and volume in the lateral ventricles can cause the laminae of the septum pellucidum to approximate and appear to fuse earlier than expected. However, the fact that the cavum septum pellucidum reappeared in this case after ventricular pressure was decreased (postventricular shunt) suggests that approximation is not the sole factor in definitive fusion of the laminae of the septum pellucidum.
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Affiliation(s)
- Howard Needelman
- Munroe-Meyer Institute for Genetics and Rehabilitation University of Nebraska Medical Center, Omaha, NE 68198-5440. USA
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22
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Filipovic B, Ilankovic N, Radonjic V, Filipovic B, Nikolic V. Large cava septi pellucidi in schizophrenic patients, alcoholics, head-traumatized, and normal individuals: morpholgical features and forensic implications. A postmortem study. Acta Neuropsychiatr 2006; 18:15-20. [PMID: 26991977 DOI: 10.1111/j.0924-2708.2006.00112.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The enlarged cava septi pellucidi (CSP = 6 mm in length) have been reported as a reliable marker of an underlying neuropsychiatric disease or disorder. Differences in the dimensions of cava longer than 6 mm associated with a neuropsychiatric impairment could be of possible clinical and forensic significance. METHODS We obtained 479 brains from autopsied persons (310 males and 169 females, aged 22-89 years) and observed that 110 brains (75 males and 35 females) had CSP, of which the length of CSP was equal to or longer than 6 mm on 69 (49 males and 20 females) of them. These cava were classified into four groups depending on the past medical histories of the autopsied person: five without neuropsychiatric history (asymptomatic CSP), 25 schizophrenic patients, 22 alcoholics, and 17 with a past head trauma (symptomatic CSP). RESULTS The linear parameters of CSP (i.e. length, width) of the symptomatic and asymptomatic groups were measured and were statistically analyzed. Analysis revealed that the cava in the group of schizophrenic patients were significantly longer and wider. CONCLUSIONS Discriminant function analysis was used to derive a mathematical formula to classify CSP into one of the groups obtained based on width measurements of the cavum.
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Affiliation(s)
- B Filipovic
- 1Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Ilankovic
- 2Department for Organic Mental Disorders, Institute of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia
| | - V Radonjic
- 1Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - B Filipovic
- 3Clinical Center 'Bezanijska Kosa', Belgrade, Serbia
| | - V Nikolic
- 1Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
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Miki T, Wada J, Nakajima N, Inaji T, Akimoto J, Haraoka J. Operative indications and neuroendoscopic management of symptomatic cysts of the septum pellucidum. Childs Nerv Syst 2005; 21:372-81. [PMID: 15654632 DOI: 10.1007/s00381-004-1063-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Since there is no current consensus on the diagnostic standards or surgical indications for symptomatic cysts of the septum pellucidum (CSP), we presented our experience treating such cases with neuroendoscopic surgery in order to possibly make a contribution to the attainment of such a consensus. METHODS In the last 5 years, we effectively treated 5 patients (4 males and 1 female) with CSP by neuroendoscopic surgery. The 3 congenital cases were young: 9, 14, and 29 years old. The 2 secondary cases were adults aged 51 and 65 years old. We were able to fenestrate, and biopsy for pathological analysis, the cyst walls of symptomatic CSP using a minimally invasive neuroendoscopic technique, with postoperative improvement in compression of adjacent structures, as well as clinical signs. CONCLUSIONS It is necessary to consider the overall picture including clinical signs, progress of the condition, intracranial pressure, and cerebral circulation, in deciding whether surgery is indicated. Neuroendoscopic surgery is an effective, optimal, and convenient therapeutic modality for symptomatic CSP.
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Affiliation(s)
- Tamotsu Miki
- Department of Neurosurgery, Tokyo Medical Universit, Japan.
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Filipović B, Teofilovski-Parapid G. Linear parameters of normal and abnormal cava septi pellucidi: a post-mortem study. Clin Anat 2005; 17:626-30. [PMID: 15494969 DOI: 10.1002/ca.20014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anatomical variations in the dimensions of different brain structures have been correlated with clinical syndromes. This study on the parameters of normal and abnormal cavum septi pellucidi (CSP) can be of clinical significance. We obtained 479 brains from autopsied persons (310 males and 169 females, 377 normal or asymptomatic and 102 abnormal or symptomatic persons, aged 22-89 years) and observed that 110 brains (75 males and 35 females) had CSP. These cava were classified into two groups depending on the past medical histories of the autopsied person: 40 asymptomatic and 70 symptomatic cava. We have defined symptomatic cava as those in autopsied persons who had known past medical history of psychiatric or neurological disease. Asymptomatic cava were in autopsied persons who had no known past medical history of psychiatric or neurological disease. The CSP parameters (length, width, depth) of the symptomatic and asymptomatic groups were measured and were statistically analyzed. Analysis showed that the cava in the symptomatic group were significantly longer and wider. Discriminant function analysis was used to derive a mathematical formula to classify CSP into an asymptomatic or symptomatic group based on length and width measurements of the cavum.
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Affiliation(s)
- Branislav Filipović
- Institute of Anatomy, School of Medicine University of Belgrade, Serbia, Montenegro, 11000 Yugoslavia.
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Filipović B, Prostran M, Ilanković N, Filipović B. Predictive potential of cavum septi pellucidi (CSP) in schizophrenics, alcoholics and persons with past head trauma. A post-mortem study. Eur Arch Psychiatry Clin Neurosci 2004; 254:228-30. [PMID: 15309391 DOI: 10.1007/s00406-004-0483-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2003] [Accepted: 12/03/2003] [Indexed: 11/24/2022]
Abstract
The increased presence of cavum septi pellucidi (CSP) was reported among people suffering from schizophrenia, alcoholism or it could be a remnant of an old head trauma. We have tried to compare not only prevalences, but also lengths, widths and depths of the obtained cava in an effort to emphasize the importance of linear parameters in routine diagnostics. On 479 cadavers, 310 male and 169 female, aged 22 to 89; 110 brains had a CSP: 40 persons had no data about prior neuropsychiatric disease, 25 were schizophrenics, 25 alcoholics and 20 received a serious head blow during their lifetime. The prevalence of CSP in the entire group was 22.96%; among normal persons 10.61%; in schizophrenics 83.33%, in alcoholics 58.14 % and in persons with sustained prior head trauma 68.96%. There was a statistically significant difference in ratings, lengths and widths of CSP between schizophrenics, alcoholics, head traumatized and normals. Both length and width were revealed as parameters of importance for CSP selection. CSP is more frequent, longer and wider in persons who are suffering from schizophrenia, alcohol addicts and those who had sustained one or several head blows in the past. Its linear parameters are advisable to be measured.
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Affiliation(s)
- Branislav Filipović
- Institute of Anatomy, 4/2 Dr Subotica, 11000 Beograd, Serbia and Montenegro.
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Abstract
In the office practice of pediatrics, the clinical threshold for order-ing imaging studies of the brain and spine has fallen in recent years, and requests have multiplied for consultation .o assess the meaning of unexpected imaging findings. Familiarity with the most common entities that precipitate such requests allows the pediatrician to allay parental anxieties with informed preliminary counseling and to set appropriate priorities for subsequent referrals and investigations.
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Affiliation(s)
- Joseph H Piatt
- Section of Neurosurgery, St. Christopher's Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134-1095, USA.
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27
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Falco P, Gabrielli S, Visentin A, Perolo A, Pilu G, Bovicelli L. Transabdominal sonography of the cavum septum pellucidum in normal fetuses in the second and third trimesters of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 16:549-553. [PMID: 11169349 DOI: 10.1046/j.1469-0705.2000.00244.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To assess the visualization rate and size of the cavum septum pellucidum (CSP) by transabdominal sonography in normal fetuses throughout pregnancy. METHODS The CSP was prospectively researched and measured using an axial transventricular plane in 286 consecutive uncomplicated singleton pregnancies between 15 and 41 weeks of gestation. RESULTS The CSP was seen in 40% of cases at 15 weeks, 82% at 16-17 weeks, 100% at 18-37 weeks and 79% at 38-41 weeks. Compared to biparietal diameter (BPD), the visualization rate was 33% between 31 and 32 mm, 45% between 33 and 34 mm, 84% between 35 and 43 mm, 100% between 44 and 88 mm and 86% between 89 and 99 mm. Mean CSP width was 5.3 +/- 1.7 mm (range 2-9 mm). The CSP width increased with gestational age and BPD but with a slight decrease around term. CONCLUSIONS In normal fetuses the CSP should always be visualized between 18 and 37 weeks, or with a BPD of 44-88 mm. Failure to observe the CSP in this interval, or possibly the presence of a large CSP, may indicate abnormal cerebral development and warrant further investigation. Conversely, absence of the CSP prior to 18 weeks, or later than 37 weeks, is a normal finding.
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Affiliation(s)
- P Falco
- Department of Obstetrics and Gynecology, University of Bologna, Italy
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Abstract
Described nearly 70 years ago as the 'punch drunk' syndrome, dementia pugilistica has recently received increasing attention in both the medical and lay press. The association between the finding of cavum septi pellucidi and dementia in old boxers was first described by Ferguson and Mawdsley in 1965. Since then it has commonly been listed as one of the features of this condition. We review the significance and the epidemiology of cavum septi pellucidi and present an alternative explantation for the association between this developmental anomaly of the brain and dementia pugilistica.
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Affiliation(s)
- J B Bodensteiner
- Department of Neurology, West Virginia University School of Medicine, Morgantown, USA.
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Swayze VW, Johnson VP, Hanson JW, Piven J, Sato Y, Giedd JN, Mosnik D, Andreasen NC. Magnetic resonance imaging of brain anomalies in fetal alcohol syndrome. Pediatrics 1997; 99:232-40. [PMID: 9024452 DOI: 10.1542/peds.99.2.232] [Citation(s) in RCA: 203] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Postmortem studies of fetuses, infants, and young children with fetal alcohol syndrome (FAS) have demonstrated a variety of severe central nervous system (CNS) anomalies. We undertook this magnetic resonance study (1) to assess the spectrum of CNS anomalies that occur in a clinical sample of typical patients with FAS who are medically stable; and (2) to examine the relationship between CNS and facial anomalies. METHODOLOGY Magnetic resonance imaging was performed on a series of 10 patients (4 children, 3 adolescents, and 3 adults) who met criteria for FAS. We systematically evaluated each scan for brain anomalies and compared total brain tissue volume with that of healthy child, adolescent, and adult control subjects. RESULTS Six patients had some type of midline anomaly, ranging from partial to complete callosal agenesis (three patients) to hypoplastic corpus callosum (one patient), cavum septi pellucidi (three patients), and cavum vergae (two patients). These midline anomalies were associated with a greater number of facial anomalies. Other brain anomalies identified included micrencephaly, ventriculomegaly, and hypoplasia of the inferior olivary eminences. CONCLUSION Patients with classic FAS have a high incidence of midline brain anomalies. This finding is consistent with the concept that the midline CNS is a developmental field that is particularly susceptible to the teratogenic effects of alcohol. Furthermore, patients with more severe facial dysmorphologic characteristics are more likely to have midline brain anomalies. In addition, we observed a high incidence of micrencephaly with a wide range of severity.
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Affiliation(s)
- V W Swayze
- Department of Psychiatry, University of Iowa Hospitals and Clinics, College of Medicine, Iowa City, USA
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Ronsin E, Grosskopf D, Perre J. Morphology and immunohistochemistry of a symptomatic septum pellucidum cavum Vergae cyst in man. Acta Neurochir (Wien) 1997; 139:366-71; discussion 372. [PMID: 9202780 DOI: 10.1007/bf01808836] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The cavum septi pellucidi (CSP) and cavum Vergae (CV) are persistent, primitive, or acquired, midline structures of adult human brain. It is customary to distinguish between the non-communicating and the communicating cava, depending on whether the cavum communicates with the cerebral ventricular system or not. Only a few cases of symptomatic non-communicating cava, called septum pellucidum and cavum Vergae cysts, have been described in the literature. In this study, the authors describe the morphological, histological and histo-immunological characteristics of an additional case of septum pellucidum-cavum Vergae cyst in a forty-year-old man who died the day following a ventriculo-peritoneal shunt. We have found a communication between the CSP and the leptomeningeal space of the anterior interhemispheric fissure, in the absence of subarachnoid haemorrhage. The authors discuss the origin of the intracystic fluid and the classification of the CSP.
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Affiliation(s)
- E Ronsin
- Laboratoire de Neurohistologie, EPHE and U106, INSERM (Ecole Pratique des Hautes Etudes, Paris, France
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31
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Lancon JA, Haines DE, Raila FA, Parent AD, Vedanarayanan VV. Expanding cyst of the septum pellucidum. Case report. J Neurosurg 1996; 85:1127-34. [PMID: 8929506 DOI: 10.3171/jns.1996.85.6.1127] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Expanding cysts of the septum pellucidum, although rare, may be a cause of significant neurological dysfunction. Most become symptomatic as a result of obstruction of the interventricular foramina and produce headaches, papilledema, emesis, and loss of consciousness. Behavioral, autonomic, and sensorimotor symptoms occur when an expanding cyst impinges on the structures of the hypothalamoseptal triangle or impairs the deep cerebral venous drainage. Neuroophthalmological symptoms may develop as a consequence of hydrocephalus or direct compression of visual structures. The authors describe the case of a young boy with an expanding septum pellucidum cyst who presented with a sudden, severe headache and loss of consciousness. In addition, he had a history of hyperactivity and progressively declining school performance. All symptoms resolved following decompression of the cyst. Seventeen cases from the literature are reviewed. The pathophysiological mechanisms underlying the development of symptoms secondary to expanding septum pellucidum cysts are outlined, and the related clinical neuroanatomy is described. A model is proposed for the natural history of expanding septum pellucidum cysts that provides a rational basis for understanding their clinical behavior and response to intervention. In most cases, fenestration or shunting will relieve the obstructive hydrocephalus and mass effect caused by the cyst and will produce rapid symptomatic improvement.
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Affiliation(s)
- J A Lancon
- Department of Neurosurgery, The University of Mississippi Medical Center, School of Medicine, Jackson 39216-4505, USA
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Wester K, Kråkenes J, Moen G. Expanding cava septi pellucidi and cava vergae in children: report of three cases. Neurosurgery 1995; 37:134-7. [PMID: 8587674 DOI: 10.1227/00006123-199507000-00021] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Three children with hydrocephalus and expanding cysts of the cavum septi pellucidi and cavum vergae are reported. In all the patients, the hydrocephalus was present before the persistent cava started to expand. The cava increased gradually, until they became cystic, but their growth did not affect the size of the ventricles. Two of the patients were treated with internal cystoventricular shunts, causing a prompt collapse of the cysts but no change in the concomitant hydrocephalus. In the third patient, the persistent cava started to expand only when a previously implanted ventriculoperitoneal shunt failed temporarily. The cyst disappeared when the shunt resumed its function. The possible mechanisms underlying the expansive growth of persistent cava are discussed. We propose the theory that the growth of the cava in our patients may be the result, rather than the cause, of the hydrocephalus.
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Affiliation(s)
- K Wester
- Department of Neurosurgery, University of Bergen School of Medicine, Haukeland Hospital, Norway
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34
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Bodensteiner JB. Southern Child Neurology Society meeting invited lecture. The saga of the septum pellucidum: a tale of unfunded clinical investigations. J Child Neurol 1995; 10:227-31. [PMID: 7642894 DOI: 10.1177/088307389501000313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J B Bodensteiner
- Division of Pediatric Neurology, West Virginia University School of Medicine, Morgantown 26506, USA
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35
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Schaefer GB, Bodensteiner JB, Thompson JN. Subtle anomalies of the septum pellucidum and neurodevelopmental deficits. Dev Med Child Neurol 1994; 36:554-9. [PMID: 7516298 DOI: 10.1111/j.1469-8749.1994.tb11888.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- G B Schaefer
- Meyer Rehabilitation Institute, University of Nebraska Medical Center, Omaha 68198-5430
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