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Alsehli H, Alshahrani SM, Alzahrani S, Ababneh F, Alharbi NM, Alarfaj N, Baarmah D. Fetal and neonatal outcomes of posterior fossa anomalies: a retrospective cohort study. Sci Rep 2024; 14:8411. [PMID: 38600369 PMCID: PMC11006671 DOI: 10.1038/s41598-024-59163-8] [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: 11/30/2023] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
The primary aim of this study was to estimate the incidence of posterior fossa anomalies (PFA) and assess the associated outcomes in King Abdulaziz Medical City (KAMC), Riyadh. All fetuses diagnosed by prenatal ultrasound with PFA from 2017 to 2021 in KAMC were analyzed retrospectively. PFA included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC), and isolated vermian hypoplasia (VH). The 65 cases of PFA were 41.5% DWM, 46.2% MCM, 10.8% VH, and 1.5% BPC. The annual incidence rates were 2.48, 2.64, 4.41, 8.75, and 1.71 per 1000 anatomy scans for 2017, 2018, 2019, 2020, and 2021, respectively. Infants with DWM appeared to have a higher proportion of associated central nervous system (CNS) abnormalities (70.4% vs. 39.5%; p-value = 0.014) and seizures than others (45% vs. 17.9%; p-value = 0.041). Ten patients with abnormal genetic testing showed a single gene mutation causing CNS abnormalities, including a pathogenic variant in MPL, C5orf42, ISPD, PDHA1, PNPLA8, JAM3, COL18A1, and a variant of uncertain significance in the PNPLA8 gene. Our result showed that the most common PFA is DWM and MCM. The autosomal recessive pathogenic mutation is the major cause of genetic disease in Saudi patients diagnosed with PFA.
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Affiliation(s)
- Hanan Alsehli
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Saeed Mastour Alshahrani
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Shatha Alzahrani
- Department of Pediatric Neurology, King Abdullah Specialist Children Hospital, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Farouq Ababneh
- Department of Genetics and Precision Medicine, King Abdullah Specialist Children Hospital, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Nawal Mashni Alharbi
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Nassebah Alarfaj
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Duaa Baarmah
- Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Gutierrez F, Ballestero M, Herrera D, Gonzalez C, Cardona A, Mora L. Occipital encephalocele associated with Dandy-Walker malformation: a case-based review. Childs Nerv Syst 2022; 38:1683-1688. [PMID: 35588332 DOI: 10.1007/s00381-022-05551-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Occipital encephalocele is a brain malformation that has been remotely associated with Dandy-Walker; only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary of the state of the art in this association. METHODS AND RESULTS The pertinent literature has been reviewed, and an exemplary case has been reported (an 11-month-old female with Dandy-Walker malformation and occipital encephalocele). So far, 33 cases have been described, with a mean age at surgery of 5, 1 day). The majority of the cases tend to present with hydrocephalus. There are no specific surgery approaches or global consensus about this association. The management possibly relies on surgery with shunt or encephalocele excision but without a dedicated protocol yet. CONCLUSIONS The clinical research on occipital encephalocele in association with Dandy-Walker malformation is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management protocol.
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Affiliation(s)
- Felipe Gutierrez
- Department of Neurosurgery, School of Medicine, University of Antioquia, Medellin, Colombia.
| | - Matheus Ballestero
- Division of Neurosurgery, Department of Medicine, Federal University of São Carlos, UFSCAR, Sao Carlos, Brazil
| | - David Herrera
- School of Medicine, Pontifical Bolivarian University, Medellin, Colombia
| | - Catalina Gonzalez
- School of Medicine, Pontifical Bolivarian University, Medellin, Colombia
| | - Alejandra Cardona
- School of Medicine, Pontifical Bolivarian University, Medellin, Colombia
| | - Laura Mora
- School of Medicine, Metropolitan University of Colombia, Barranquilla, Colombia
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Moodley AW, Nel S, Oosthuizen E, Lundgren C. Anaesthetic management for ventriculoperitoneal shunt insertion in an infant with Dandy–Walker Syndrome. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1283741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alastair Wayne Moodley
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Steven Nel
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eduard Oosthuizen
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Lundgren
- Department of Anaesthesia, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kusumoto Y, Shinozuka O. Oral findings and dental treatment in a patient with Dandy-Walker syndrome: a case report. SPECIAL CARE IN DENTISTRY 2014; 34:151-5. [PMID: 24712511 DOI: 10.1111/scd.12044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dandy-Walker syndrome (DWS) is congenital disease characterized by hypoplasia of the cerebellum, the formation of cysts that communicate with the fourth ventricle of the posterior cranial fossa, and hydrocephalus. In addition to various other complications, cleft lip/palate, facial retrognathia, a high-arched palate, and maldentition occur at an increased frequency in patients with DWS. However, few studies have reported the dental manifestations of DWS. Herein, we report the clinical manifestations, oral findings, and dental management of a DWS patient who was treated under general anesthesia. Poor oral hygiene, gingivitis, and several congenital dental abnormalities (e.g., generalized microdontia, conical tooth, transposition, and congenitally missing teeth) were observed. This report is the first to describe the oral findings and dental treatment of DWS. Our findings emphasize the importance of a multidisciplinary approach in the diagnosis and treatment of DWS.
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Affiliation(s)
- Yasuka Kusumoto
- Section of Dentistry for Persons with Disabilities, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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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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Mandiwanza T, Kaliaperumal C, Caird J. Central brain herniation in shunted Dandy Walker cyst. Childs Nerv Syst 2013; 29:1035-8. [PMID: 23479270 DOI: 10.1007/s00381-013-2066-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/25/2013] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Dandy-Walker Syndrome (DWS) is a constellation of congenital anomalies of the central nervous system consisting of cerebellar vermis hypoplasia or agenesis, cystic dilatation of the fourth ventricle, enlarged posterior fossa, and a high tentorium. Hydrocephalus is a common occurrence in DWS and its treatment varies between shunting-ventriculoperitoneal or cystoperitoneal or both, endoscopic cyst fenestration, and third ventriculostomy. Chronic cerebral herniation is a known complication of treatment in DWS; however, we present an unusual case of central brain herniation. CASE REPORT A 2 year old boy with shunted DWS presented with status epilepticus. Initial CT brain scan showed no increase in ventricle or cyst size; however, tapping the shunt reservoir did not yield any CSF prompting a shunt revision. Postoperatively, he was very slow to wake and subsequently experienced an episode of fixed pupils and extensor posturing. MRI brain demonstrated severe herniation of both thalami through the tentorium. CONCLUSION This child had chronic central brain herniation (CCBH) secondary to the shunting of his cyst. To our knowledge, this is the first case of CCBH following treatment of DW cyst.
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Affiliation(s)
- Tafadzwa Mandiwanza
- Paediatric Neurosurgery Department, Children's University Hospital, Temple Street, Dublin 1, Ireland.
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Jha VC, Kumar R, Srivastav AK, Mehrotra A, Sahu RN. A case series of 12 patients with incidental asymptomatic Dandy-Walker syndrome and management. Childs Nerv Syst 2012; 28:861-7. [PMID: 22476659 DOI: 10.1007/s00381-012-1734-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 02/27/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Incidentally detected asymptomatic Dandy-Walker syndrome (DWS) is sparsely reported in literature at extremes of age (from 1 to 75 years) in association with different diseases. Precipitating factors causing DWS in these cases to manifest in late adulthood are still unidentified. We tried to hypothesize the aetiology and the natural course of disease based on review of literature MATERIAL AND METHODS Twelve cases of asymptomatic DWS were selected retrospectively in this study while being treated for some unrelated disease over a period of 15 years. RESULTS All the cases had vermian hypoplasia with sizeable fourth ventricular cyst (more than 3 cm), large posterior fossa and with no or borderline ventriculomegaly on CT/MRI. The age ranged from 1 to 65 years. Five cases presented with head injury and four cases presented with enlarged head size with suboccipital protuberance (noticed in children more than 5 years). Remaining cases presented with either occipital encephalocele or right trigeminal neuralgia or fixed atlantoaxial dislocation. They were asymptomatic for DWS following treatment of the presenting complaints on follow-up of average duration of 4.5 years. CONCLUSION Presentation at extremes of age signifies that slow degenerative changes in communicating channels between fourth ventricular cyst and surrounding basal cisterns may cause asymptomatic DWS to manifest, but cases having good communication between these structures can remain asymptomatic throughout their life.
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Affiliation(s)
- Vikas Chandra Jha
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Correa GG, Amaral LF, Vedolin LM. Neuroimaging of Dandy-Walker malformation: new concepts. Top Magn Reson Imaging 2011; 22:303-312. [PMID: 24132069 DOI: 10.1097/rmr.0b013e3182a2ca77] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dandy-Walker malformation (DWM) is the most common human cerebellar malformation, characterized by hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and an enlarged posterior fossa with upward displacement of the lateral sinuses, tentorium, and torcular. Although its pathogenesis is not completely understood, there are several genetic loci related to DWM as well as syndromic malformations and congenital infections. Dandy-Walker malformation is associated with other central nervous system abnormalities, including dysgenesis of corpus callosum, ectopic brain tissue, holoprosencephaly, and neural tube defects. Hydrocephalus plays an important role in the development of symptoms and neurological outcome in patients with DWM, and the aim of surgical treatment is usually the control of hydrocephalus and the posterior fossa cyst. Imaging modalities, especially magnetic resonance imaging, are crucial for the diagnosis of DWM and distinguishing this disorder from other cystic posterior fossa lesions. Persistent Blake's cyst is seen as a retrocerebellar fluid collection with cerebrospinal fluid signal intensity and a median line communication with the fourth ventricle, commonly associated with hydrocephalus. Mega cisterna magna presents as an extraaxial fluid collection posteroinferior to an intact cerebellum. Retrocerebellar arachnoid cysts frequently compress the cerebellar hemispheres and the fourth ventricle. Patients with DWM show an enlarged posterior fossa filled with a cystic structure that communicates freely with the fourth ventricle and hypoplastic vermis. Comprehension of hindbrain embryology is of utmost importance for understanding the cerebellar malformations, including DWM, and other related entities.
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Affiliation(s)
- Gustavo Gumz Correa
- From the *Hospital Moinhos de Vento, Porto Alegre; and †Medimagem, Hospital Beneficiência Portuguesa, São Paulo, Brazil
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Spennato P, Mirone G, Nastro A, Buonocore MC, Ruggiero C, Trischitta V, Aliberti F, Cinalli G. Hydrocephalus in Dandy-Walker malformation. Childs Nerv Syst 2011; 27:1665-81. [PMID: 21928031 DOI: 10.1007/s00381-011-1544-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Even if the first description of Dandy-Walker dates back 1887, difficulty in the establishment of correct diagnosis, especially concerning differential diagnosis with other types of posterior fossa CSF collection, still persists. Further confusion is added by the inclusion, in some classification, of different malformations with different prognosis and therapeutic strategy under the same label of "Dandy-Walker". METHODS An extensive literature review concerning embryologic, etiologic, pathogenetic, clinical and neuroradiological aspects has been performed. Therapeutic options, prognosis and intellectual outcome are also reviewed. CONCLUSION The correct interpretation of the modern neuroradiologic techniques, including CSF flow MR imaging, may help in identifying a "real" Dandy-Walker malformation. Among therapeutical strategies, single shunting (ventriculo-peritoneal or cyst-peritoneal shunts) appears effective in the control of both ventricle and cyst size. Endoscopic third ventriculostomy may be considered an acceptable alternative, especially in older children, with the aim to reduce the shunt-related problems. Prognosis and intellectual outcome mostly depend on the presence of associated malformations, the degree of vermian malformation and the adequate control of hydrocephalus.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono Children's Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
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Turner MS, Nguyen HS, Payner TD, Cohen-Gadol AA. A novel method for stereotactic, endoscope-assisted transtentorial placement of a shunt catheter into symptomatic posterior fossa cysts. J Neurosurg Pediatr 2011; 8:15-21. [PMID: 21721883 DOI: 10.3171/2011.4.peds10541] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECT Posterior fossa cysts are usually divided into Dandy-Walker malformations, arachnoid cysts, and isolated and/or trapped fourth ventricles. Shunt placement is a mainstay treatment for decompression of these fluid collections when their expansion becomes symptomatic. Although several techniques to drain symptomatic posterior fossa cysts have been described, each method carries its own advantages and disadvantages. This article describes an alternative technique. METHODS In 10 patients, the authors used an alternative technique involving stereotactic and endoscopic methods to place a catheter in symptomatic posterior fossa cysts across the tentorium. Discussion of these cases is included, along with a review of various approaches to shunt placement in this region and recommendations regarding the proposed technique. RESULTS No patient suffered intracranial hemorrhage related to the procedure and catheter implantation. All 3 patients who underwent placement of a new transtentorial cystoperitoneal shunt and a new ventriculoperitoneal shunt did not suffer any postoperative complication; a decrease in the size of their posterior fossa cysts was evident on CT scans obtained during the 1st postoperative day. Follow-up CT scans demonstrated either stable findings or further interval decrease in the size of their cysts. In 1 patient, the postoperative head CT demonstrated that the transtentorial catheter terminated posterior to the right parietal occipital region without entering the retrocerebellar cyst. This patient underwent a repeat operation for proximal shunt revision, resulting in an acceptable catheter implantation. The patient in Case 8 suffered from a shunt infection and subsequently underwent hardware removal and aqueductoplasty with stent placement. The patient in Case 9 demonstrated a slight increase in fourth ventricle size and was returned to the operating room. Exploration revealed a kink in the tubing connecting the distal limb of the Y connector to the valve. The Y connector was replaced with a T connector, and 1 week later, CT scans exhibited interval decompression of the ventricles. This patient later presented with cranial wound breakdown and an exposed shunt. His shunt hardware was removed and he was treated with antibiotics. He later underwent reimplantation of a lateral ventricular and transtentorial shunt and suffered no other complications during a 3-year follow-up period. CONCLUSIONS The introduction of endoscopic and stereotactic techniques has expanded the available treatment possibilities for posterior fossa cysts.
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Affiliation(s)
- Michael S Turner
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University, Indianapolis 46202, Indiana
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Successful treatment of Dandy-Walker syndrome by endoscopic third ventriculostomy in a 6-month-old girl with progressive hydrocephalus: a case report and literature review. Pediatr Neonatol 2011; 52:42-5. [PMID: 21385657 DOI: 10.1016/j.pedneo.2010.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 01/08/2010] [Accepted: 02/01/2010] [Indexed: 11/24/2022] Open
Abstract
Dandy-Walker syndrome (DWS) is a congenital brain malformation involving the cerebellum and fourth ventricle. We report a 6-month-old girl with DWS presenting an initially normal ventricular system and mild cyst-like lesion over the posterior fossa as assessed by postnatal brain sonography. However, symptoms and signs of increased intracranial cerebral pressure in terms of frequent vomiting and tense anterior fontanel developed, and these were associated with mild hypotonia and poor neck support, and upward-gaze palsy at the age of 6 months. Magnetic resonance imaging revealed a huge cystic lesion of the fourth ventricle, which filled the posterior fossa and ventricular dilatation. The tentorium was progressively displaced upward by the cyst. A nearly complete agenesis of the cerebellar vermis was also confirmed. After a successful endoscopic third ventriculostomy, a series of brain magnetic resonance imaging scans, taken during a follow-up survey, showed normal lateral and third ventricles. Consequently, symptoms of intracranial cerebral pressure resolved, and a developmental milestone was achieved. In conclusion, DWS can be confirmed postpartum, and endoscopic third ventriculostomy was found to be a preferential operative procedure for DWS with hydrocephalus. It may be effective for patients younger than 1 year.
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Abstract
Dandy-Walker malformation is a congenital disorder that involves the cerebellum and fourth ventricle. Regarding treatment, there is still controversy over the optimum surgical management. In the current study, we present 19 consecutive cases of Dandy-Walker malformation diagnosed between January 1992 and January 2008 that were treated in our institute. All patients presented with hydrocephalus at the time of diagnosis and were treated surgically. Combined drainage of the ventricular system and posterior fossa cyst, using a 3-way connector was performed in 5 patients. Posterior fossa cyst drainage alone was performed in 10 patients and the remaining 4 patients were treated by ventricular drainage alone. All patients improved after treatment. Dandy-Walker malformation is a developmental abnormality of the central nervous system associated with various brain and extracranial abnormalities. Surgical treatment remains controversial, whereas prognosis varies greatly according to the severity of syndrome and associated comorbidities.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, Children's Hospital Agia Sofia, Athens, Greece.
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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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Mohanty A, Biswas A, Satish S, Praharaj SS, Sastry KVR. Treatment options for Dandy-Walker malformation. J Neurosurg 2007; 105:348-56. [PMID: 17328256 DOI: 10.3171/ped.2006.105.5.348] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECT The aim of this study was to assess the efficacy of various treatment options available for children with Dandy-Walker malformation (DWM) and to evaluate the role of endoscopic procedures in the treatment of this disorder. METHODS The authors conducted a retrospective review of 72 children who underwent surgical treatment for DWM during a 16-year period. All patients underwent computed tomography scanning, and 26 underwent magnetic resonance (MR) imaging. The initial surgical treatment included ventriculoperitoneal (VP) shunt placement in 21 patients, cystoperitoneal (CP) shunt placement in 24, and combined VP and CP shunt insertion in three. Twenty-one patients underwent endoscopic procedures (endoscopic third ventriculostomy [ETV] alone in 16 patients, ETV with aqueductal stent placement in three, and ETV with fenestration of the occluding membrane in two). Three patients underwent membrane excision via a posterior fossa craniectomy. In the 26 patients who had undergone preoperative MR imaging, aqueductal patency was noted in 23 and aqueductal obstruction in three. These three patients underwent placement of a stent from the third ventricle to the posterior fossa cyst in addition to the ETV procedure. During the follow-up period, 12 patients with a CP shunt and four with a VP shunt experienced shunt malfunctions that required revision. Four patients with a CP shunt also required placement of a VP shunt. In addition, five of the 21 ETVs failed, requiring VP shunt insertion. A reduction in ventricle size noted on postoperative images occurred more frequently in patients with a VP shunt, whereas a reduction in cyst size was more appreciable in patients with a CP shunt. Successful ETV resulted in a slight decrease in ventricle size and varying degrees of reduction in cyst size. CONCLUSIONS Endoscopic procedures may be considered an acceptable alternative in children with DWM. The authors propose a treatment protocol based on preoperative MR imaging findings of associated aqueductal stenosis.
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Affiliation(s)
- Aaron Mohanty
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
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Yüceer N, Mertol T, Arda N. Surgical treatment of 13 pediatric patients with Dandy-Walker syndrome. Pediatr Neurosurg 2007; 43:358-63. [PMID: 17785999 DOI: 10.1159/000106383] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 02/05/2007] [Indexed: 12/16/2022]
Abstract
We present our experience with the treatment of 13 patients with Dandy-Walker syndrome. The common presenting symptom and associated central nervous system anomaly were enlargement of head and occipital encephalocele, respectively. Eleven out of 13 patients were treated surgically after stabilization of systemic medical status. Two patients could not be operated because of poor medical condition. In 6 patients with an opened passage between posterior fossa cyst and lateral ventricle, cystoperitoneal shunt system with medium pressure valve was the treatment of choice. In 5 patients with no relation between cyst and ventricle, cystoperitoneal and ventriculoperitoneal shunting with 'Y' connectors were applied separately. Another patient with a shunt infection was treated by shunt system renewal combined with parenteral antibiotics. One patient died 7 months after the operation due to recurrent meningitis.
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Affiliation(s)
- Nurullah Yüceer
- Department of Neurosurgery, School of Medicine, University of Dokuz Eylul, Izmir, Turkey.
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Heyer GL, Millar WS, Ghatan S, Garzon MC. The neurologic aspects of PHACE: case report and review of the literature. Pediatr Neurol 2006; 35:419-24. [PMID: 17138012 DOI: 10.1016/j.pediatrneurol.2006.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 05/18/2006] [Accepted: 06/26/2006] [Indexed: 11/28/2022]
Abstract
PHACE syndrome is a neurocutaneous disorder characterized by large cervicofacial infantile hemangiomas and associated anomalies of the brain, cerebrovasculature, aorta, heart, and eyes. Two categories of neurologic disease are observed among PHACE patients: congenital malformations of the cerebellum, cerebrum, and cerebral vasculature and progressive stenoses and occlusions of principal cerebral arteries. A subgroup of patients develops a moyamoya-like vasculopathy and consequent ischemic strokes. This report details the clinical course and management of a young female with PHACE and reviews the various neurologic aspects of this neurocutaneous disorder. This patient presented with high-grade stenoses of the internal carotid arteries bilaterally, formation of extensive vascular collaterals, and multiple ischemic strokes. She underwent bilateral pial-synangiosis procedures and has not had stroke recurrence in 2 years of follow-up. The presence of a characteristic infantile hemangioma necessitates further evaluation for the extracutaneous features of PHACE. In cases of steno-occlusive vasculopathy, we recommend early consideration of encephaloduroarteriosynangiosis or a commensurate revascularization procedure.
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Affiliation(s)
- Geoffrey L Heyer
- Department of Neurology, Columbia University, New York, New York, USA.
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18
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Abstract
The aim of this review is to summarize our knowledge about Dandy-Walker malformation (DWM) and introduce recent notions about its prognosis. DWM is a malformation associating hypoplasia of the vermis, pseudocystic fourth ventricle, upward displacement of the tentorium, torcular and lateral sinuses and anterio-posterior enlargement of the posterior fossa. It is frequently associated with genetic anomalies, brain malformations (anomalies of gyration, grey matter heterotopias, meningoceles, corpus callosum agenesis...) or systemic malformations (heart, orthopedic, intestinal, urogenital and facial anomalies). It is also part of many syndromes. Its rarity, the difficulty of its diagnosis, the fact that the malformation is mainly known through hospitalized patients, mainly from neurosurgical departments, have made its definition variable and prevents us from having an accurate knowledge of its natural history and prognosis. Hydrocephalus, so frequent in neurosurgical series that some have included it in the definition, is actually rare as has been seen in prenatal series. Treatment, when necessary, is still controversial, the main options remaining cyst fenestration, ventriculo- and/or cystoperitoneal shunts and more recently endoscopic third ventriculostomy. The prognosis, commonly said to be unpredictable, is actually foreseeable after scrutinous observation of the brain anatomy, and mainly of the vermis. A cerebellar vermis with three groups of lobes and two main fissures, as identified on MRI T2 sagittal views, not only has the greatest chance to not be associated with other malformation but also to have a favorable neurocognitive outcome. On the contrary, a deeply dysgenetic vermis with only two or one recognizable lobes is not only constantly associated with other brain malformation but also with poor prognosis. This is a recent advance that may be important for those involved in prenatal counselling.
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Affiliation(s)
- O Klein
- Unité de Neurochirurgie Pédiatrique, Département de Neurochirurgie, Hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex.
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19
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Bragg TWH, St George EJ, Wynne-Jones GA, Hockley A, Morton JEV. Familial Dandy-Walker syndrome: a case report supporting an autosomal inheritance. Childs Nerv Syst 2006; 22:539-41. [PMID: 16261385 DOI: 10.1007/s00381-005-0007-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We report an isolated pedigree in which a consanguineous couple had twin sons with Dandy-Walker malformation (DWM). The mother is similarly affected with the disorder. DISCUSSION DWM is an abnormality of the central nervous system, which leads to hydrocephalus and is associated with other abnormalities. CONCLUSION Inheritance of the disorder remains controversial, with the majority perceived to be sporadic cases. This report suggests an autosomal inheritance.
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Affiliation(s)
- Thomas W H Bragg
- Department of Neurosurgery, Diana Princess of Wales Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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20
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LIMPEROPOULOS C, ROBERTSON RL, ESTROFF JA, BARNEWOLT C, LEVINE D, BASSAN H, du PLESSIS AJ. Diagnosis of inferior vermian hypoplasia by fetal magnetic resonance imaging: potential pitfalls and neurodevelopmental outcome. Am J Obstet Gynecol 2006; 194:1070-6. [PMID: 16580298 PMCID: PMC1557637 DOI: 10.1016/j.ajog.2005.10.191] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 09/06/2005] [Accepted: 10/05/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Advances in fetal magnetic resonance imaging allow the detection of subtle anatomic anomalies of unclear long-term clinical significance. The purpose of this study was to examine the accuracy of fetal magnetic resonance imaging in the diagnosis of isolated inferior vermian hypoplasia and to describe the neurodevelopmental outcome. STUDY DESIGN We reviewed all cases with fetal and postnatal magnetic resonance imaging studies between 1999 and 2003 and identified 19 cases with a diagnosis of isolated inferior vermian hypoplasia. We compared prenatal and postnatal magnetic resonance imaging studies and evaluated subjects using developmental scales. RESULTS Isolated inferior vermian hypoplasia was confirmed by postnatal magnetic resonance imaging in 68% of the patients (13/19); the remaining 6 patients had normal postnatal magnetic resonance imaging results. On developmental testing at mean age 19.8 +/- 4.9 months, 3 infants (23%) with confirmed postnatal diagnosis demonstrated motor and language delays and functional difficulties, and 2 infants (15%) had behavioral problems; none of the infants with normal postnatal magnetic resonance imaging studies were delayed. CONCLUSION Isolated inferior vermian hypoplasia in the second trimester may be over-diagnosed by fetal magnetic resonance imaging and therefore warrants postnatal magnetic resonance imaging confirmation.
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Affiliation(s)
- Catherine LIMPEROPOULOS
- Boston MA, USA. Fetal-Neonatal Neurology Research Group, Department of Neurology
- Corresponding Author: Catherine Limperopoulos, PhD, Department of Neurology, Fegan 11, Children’s Hospital Boston, 300 Longwood Avenue, Boston MA 02115, Phone 617-355-8025, Fax 617-730-0279, E-mail
| | | | - Judy A. ESTROFF
- Department of Radiology, and
- Advanced Fetal Care Center, Children’s Hospital Boston and Harvard Medical School
| | - Carol BARNEWOLT
- Department of Radiology, and
- Advanced Fetal Care Center, Children’s Hospital Boston and Harvard Medical School
| | - Deborah LEVINE
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Haim BASSAN
- Boston MA, USA. Fetal-Neonatal Neurology Research Group, Department of Neurology
| | - Adré J. du PLESSIS
- Boston MA, USA. Fetal-Neonatal Neurology Research Group, Department of Neurology
- Advanced Fetal Care Center, Children’s Hospital Boston and Harvard Medical School
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21
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Kronenberg A, Blei F, Ceisler E, Steele M, Furlan L, Kodsi S. Ocular and systemic manifestations of PHACES (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Cardiac defects and coarctation of the Aorta, Eye abnormalities, and Sternal abnormalities or ventral developmental defects) syndrome. J AAPOS 2005; 9:169-73. [PMID: 15838446 DOI: 10.1016/j.jaapos.2004.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION PHACES syndrome (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Cardiac defects and coarctation of the aorta, Eye abnormalities, and Sternal abnormalities or ventral developmental defects) is a rare neurocutaneous syndrome with only 2 case reports published in the ophthalmic literature. This study was conducted to identify ocular and systemic manifestations of PHACES syndrome. METHODS A retrospective chart review was performed on 8 children with a diagnosis of PHACES syndrome. Information recorded included age at first visit, length of follow-up, gender, race, vision, need for glasses, strabismus, amblyopia, ptosis, proptosis, anterior and posterior segment abnormalities, need for treatment of the hemangioma, type of treatment of the hemangioma, and systemic manifestations. RESULTS Periocular and ocular findings in patients with PHACES syndrome included hemangioma involving ocular structures (n = 6), strabismus (n = 4), amblyopia (n = 5), proptosis (n = 2), ptosis (n = 5), anterior polar cataract (n = 1), optic atrophy from optic neuropathy (n = 1), heterochromia (n = 1), and refractive error requiring glasses (n = 2). All patients were treated with steroids for the hemangioma. Systemic manifestations of PHACES syndrome included posterior fossa malformation (n = 4), hemangioma (n = 8), arterial anomalies (n = 3), cardiac abnormalities (n = 3), and sternal or ventral deformities (n = 3). CONCLUSION Children with PHACES syndrome may have significant ocular and systemic abnormalities and are at increased risk for strabismus and amblyopia. They often require steroid therapy of the hemangioma to prevent and/or treat ocular complications. These patients require careful monitoring by a pediatric ophthalmologist in addition to other subspecialists.
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Affiliation(s)
- Alaina Kronenberg
- Department of Ophthalmology, Long Island Jewish Medical Center, North Shore-Long Island Health Systems, Great Neck, NY, USA
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22
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Abstract
This article outlines the clinical, central nervous system, and neuropathologic features,pathogenesis, genetics, molecular biology, and neuroimaging characteristics of the rare vascular phakomatoses, melanophakomatoses, and organoid phakomatoses.
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Affiliation(s)
- Simon Edelstein
- Department of Radiology, MIA Group Limited Box Hill Hospital, Melbourne, Australia
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23
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Bronzetti G, Giardini A, Patrizi A, Prandstraller D, Donti A, Formigari R, Bonvicini M, Picchio FM. Ipsilateral hemangioma and aortic arch anomalies in posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta, and cardiac defects and eye abnormalities (PHACE) anomaly: report and review. Pediatrics 2004; 113:412-5. [PMID: 14754961 DOI: 10.1542/peds.113.2.412] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta, and cardiac defects and eye abnormalities (PHACE) is a rare congenital anomaly with a broad spectrum of clinical manifestations with a striking female predominance. We describe an infant with PHACE anomaly and aortic coarctation who underwent cardiac catheterization to clearly define the complex anatomy of the aortic lesion before surgical repair. Review of the literature documents a highly significant association between ipsilateral hemangiomas and cerebrovascular and aortic arch anomalies. We conclude that cardiac catheterization is required to define the complex anatomy of aortic lesions and should be performed in all patients with PHACE and evident aortic involvement to plan appropriate and safe surgical repair.
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Affiliation(s)
- Gabriele Bronzetti
- Pediatric Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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24
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Parisi MA, Dobyns WB. Human malformations of the midbrain and hindbrain: review and proposed classification scheme. Mol Genet Metab 2003; 80:36-53. [PMID: 14567956 DOI: 10.1016/j.ymgme.2003.08.010] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although a great deal of interest in the genetics and etiology of cerebral, particularly forebrain, malformations has been generated in the past decade, relatively little is known about the basis of congenital malformations of the structures of the posterior fossa, namely the midbrain, cerebellum, pons, and medulla. In this review, we present a classification scheme for malformations of the midbrain and hindbrain based on their embryologic derivation, highlight four of the conditions associated with such abnormalities, and describe the genetics, prognosis, and recurrence risks for each. We describe several disorders in addition to Joubert syndrome with the distinctive radiologic sign known as the "molar tooth sign," comprised of midbrain and hindbrain malformations. We discuss Dandy-Walker malformation, its classical definition, and the surprisingly good outcome in the absence of other brain malformations. We consider the heterogeneous entity of cerebellar vermis hypoplasia and describe the recently identified gene associated with an X-linked form of this condition. Finally, the pontocerebellar hypoplasias are discussed in the context of their generally progressive degenerative and severe course, and the differential diagnosis is emphasized. We anticipate that as imaging technologies improve, differentiation of the various disorders should aid in efforts to identify the causative genes.
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Affiliation(s)
- Melissa A Parisi
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
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25
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Abstract
INTRODUCTION Neonatal hydrocephalus is one of the most common congenital anomalies affecting the nervous system. DISCUSSION Currently, ultrasonography allows for early detection of fetal ventriculomegaly and presents the family with several treatment options: termination of pregnancy, early delivery and neonatal shunting, and delivery at term followed by shunting. Despite ventricular decompression after birth, the cognitive outcome is variable as prolonged in utero hydrocephalus has a detrimental effect. In the early 1980s, fetal intervention was explored with the intention of improving outcome. However, patient selection was poor. Fetal ventriculomegaly from other conditions was not adequately distinguished from fetal hydrocephalus. In addition, fetal surgical techniques were not advanced. Consequently, the results were poor and a de facto moratorium on fetal shunting was imposed. However, recent improvements in fetal imaging, such as magnetic resonance imaging, and advances in fetal surgical techniques offer the possibility that properly selected fetuses with hydrocephalus can benefit from an in utero intervention.
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Affiliation(s)
- Cornelia S von Koch
- Department of Neurological Surgery, University of California San Francisco, Room M-779, 505 Parnassus Avenue, Box 0112, San Francisco, CA 94143-0112, USA.
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26
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Abstract
Congenital anomalies of the central nervous system (CNS) are among the most frequent malformations. Current ultrasound equipment can give a precise diagnosis of many of these lesions from early gestation. High-resolution transvaginal probes play a major role both in allowing an early diagnosis and for better defining subtle details of both normal and abnormal cerebral anatomy. The diagnostic accuracy of prenatal ultrasound is, however, heavily dependent upon the expertise of the sonologist, the type of equipment employed, and the time dedicated to the scan. Fetal sonography is effective in identifying neural tube defects, although alpha-fetoprotein screening seems to give a greater sensitivity. The accuracy of ultrasound in the identification of CNS malformations other than neural tube defects remains unclear because of the ascertainment biases of the few large prospective studies that have been conducted to date.
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Affiliation(s)
- Gianluigi Pilu
- Department of Obstetrics and Gynecology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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27
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Gupta AR, Gupta PD, Vsm M. A LARGE ASYMPTOMATIC DANDY WALKER CYST IN AN INFANTRY SOLDIER. Med J Armed Forces India 2002; 58:171-2. [PMID: 27407371 DOI: 10.1016/s0377-1237(02)80060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- A R Gupta
- Classified Specialist (Anaesthesia & Neuroanaesthesia), Command Hospital, (Western Command), Chandimandir-134 107
| | - P D Gupta
- Classified Specialist (Surgery), Command Hospital, (Western Command), Chandimandir-134 107
| | - Maini Vsm
- Senior Adviser (Anaesthesia), Command Hospital, (Western Command), Chandimandir-134 107
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28
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Abstract
OBJECTIVES PHACE is an acronym coined to describe a neurocutaneous syndrome encompassing the following features: posterior fossa brain malformations, large facial hemangiomas, arterial anomalies, cardiac anomalies and aortic coarctation, and eye abnormalities. We evaluated the spectrum of disease and significance of potential underlying brain anomalies among affected children. STUDY DESIGN The records of 14 patients with PHACE syndrome, evaluated between 1995 and 2000, were retrospectively reviewed. A literature review revealed 116 additional cases. RESULTS PHACE syndrome represents a spectrum of anomalies, because most affected children have only one extracutaneous manifestation. The syndrome is associated with a high incidence of arterial and structural central nervous system anomalies with secondary neurologic sequelae. The potential for progressive neurovascular disease also exists among those patients with anomalous vasculature. CONCLUSION PHACE syndrome should be considered in any infant presenting with a large, segmental, plaque-type facial hemangioma. Children at risk should receive careful ophthalmologic, cardiac, and neurologic assessment.
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Affiliation(s)
- D W Metry
- Departments of Dermatology, Pediatrics, and Radiology, Baylor College of Medicine, Houston, Texas, USA
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29
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Scher MS. Fetal and neonatal neurologic consultations: identifying brain disorders in the context of fetal-maternal-placental disease. Semin Pediatr Neurol 2001; 8:55-73. [PMID: 11464959 DOI: 10.1053/spen.2001.24837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric neurologists provide an important consultative role for the fetus or neonate with a suspected brain disorder. Although most consultations are initiated after birth, neonatal neurologic dysfunction may be reflective of fetal brain damage or maldevelopment. Maternal or placental/cord disease states can predispose the fetus or neonate to brain disorders during the antepartum, intrapartum, or early postpartum periods. Neurologists must therefore consider maternal, placental, and fetal conditions on which a neonatal encephalopathy may be superimposed, with or without recent brain injury. This review suggests how the pediatric neurologist can contribute more effectively to fetal and neonatal neurologic evaluations regarding etiologies and mechanisms of brain injury; their role will enhance diagnostic services composed of maternal-fetal specialists, placental and pediatric pathologists, neonatologists, neurosurgeons, geneticists, and other pediatric subspecialists. Selected examples of structural markers during fetal life, and functional markers during neonatal life, illustrate the wide spectrum of disease states that are highly dependent on the timing and location of brain injury. The pediatric neurologist has the opportunity to integrate these complementary lines of investigation into a responsive consultative opinion, which is both medically accurate and ethical, responsible to the welfare of the mother and child.
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Affiliation(s)
- M S Scher
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106-1736, USA
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30
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31
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Abstract
SURGERY BEFORE BIRTH has been performed for lethal conditions for several years. The techniques that have been developed are being applied to nonlethal conditions such as meningomyelocele. It is possible that fetal surgery might find a place in the management of certain forms of hydrocephalus as well. The challenge is to define which patients might benefit from such radical procedures before these techniques are accepted as standard care.
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Affiliation(s)
- L N Sutton
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, USA.
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32
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Abstract
Fetal central nervous system abnormalities encompass a variety of lesions. Most of the anomalies are seen in association with an increased incidence of fetal aneuploidy and an increase in other anomalies both within and outside of the central nervous system. These associated findings and the underlying lesion all have a role in the eventual prognosis for the ongoing pregnancy. The antenatal diagnosis of a central nervous system abnormality should prompt a careful search for other defects, and consideration should be given for genetic evaluation and testing.
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Affiliation(s)
- R A Bronsteen
- Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan, USA
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33
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Beke A, Csabay L, Rigó J, Harmath A, Papp Z. Follow-up studies of newborn-babies with congenital ventriculomegaly. J Perinat Med 2000; 27:495-505. [PMID: 10732310 DOI: 10.1515/jpm.1999.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The authors present the results of their follow-up studies of data from the last four years on patients with congenital ventriculomegaly. OBJECTIVE To study the psychomotor and mental developmental outcome of neonates with congenital ventriculomegaly diagnosed prenatally. In addition, patients were also classified into subgroups with subgrouping based on the etiology and complications of congenital ventriculomegaly and on the absence of ventriculoperitoneal shunt placement, and the findings compared between the different subgroups. METHODS Level 3 fetal ultrasonography was used for the prenatal diagnosis of congenital ventriculomegaly in 30 infants. Using neurological examination and the modified Brunet-Lézine infant test performed postnatal follow-up of motor and sensory development and intelligence, respectively. RESULTS The results show thirteen symptomless, well-developing patients, ten moderately handicapped patients and seven severely handicapped patients. Newborns with isolated, moderate ventriculomegaly have the best outcome.
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Affiliation(s)
- A Beke
- 1st Department of Obstetrics and Gynecology, Semmelweis University Medical School, Budapest, Hungary
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34
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Coats DK, Paysse EA, Levy ML. PHACE: a neurocutaneous syndrome with important ophthalmologic implications: case report and literature review. Ophthalmology 1999; 106:1739-41. [PMID: 10485544 DOI: 10.1016/s0161-6420(99)90350-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To introduce PHACE syndrome (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Coarctation of the aorta and other cardiac defects, and Eye abnormalities) to the ophthalmologic literature; to report the first case of PHACE syndrome associated with congenital glaucoma; and to review the ocular and systemic findings that may occur in this entity. DESIGN Case report and literature review. METHODS The authors report a child with PHACE syndrome and congenital glaucoma and review the ophthalmologic and systemic manifestations of this syndrome. RESULTS A 9-month-old girl with PHACE syndrome was treated. She had a large right facial hemangioma, central nervous system (CNS) abnormalities, and cardiac anomalies. Glaucoma was detected in her left eye, and she underwent glaucoma surgery. She did well following two glaucoma procedures, and the facial hemangioma is responding to medical treatment. CONCLUSIONS Ophthalmologists who examine children with large facial hemangiomas should consider PHACE syndrome in the differential diagnosis and should obtain appropriate CNS imaging studies and cardiac evaluation when the diagnosis is suspected. Congenital glaucoma should be added to the list of PHACE-associated ocular anomalies.
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Affiliation(s)
- D K Coats
- Department of Ophthalmology, Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA.
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35
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Cassidy L, Cassels-Brown A, Soulioti A. Orbital glial hamartoma and anophthalmos in Dandy-Walker syndrome. Neuroophthalmology 1998. [DOI: 10.1076/noph.19.2.107.3948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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36
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Abstract
Hydromyelia is a dilation of the spinal cord central canal. In man this may be due to congenital malformations such as Dandy-Walker syndrome and Chiari malformations or may be acquired as result of infection, trauma or neoplasia. In dogs hydromyelia may be accidentally diagnosed during routine cisterna magna myelography. Hydromyelia, and its possible etiology, may be confirmed by means of computed tomography or magnetic resonance imaging. Three dogs with hydromyelia due to differing etiologies are described.
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Affiliation(s)
- R M Kirberger
- Department of Surgery, Onderstepoort Veterinary Academic Hospital, University of Pretoria, Republic of South Africa
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37
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Abstract
A patient with radiographically confirmed Dandy-Walker syndrome who presented with opisthotonus, a rarely reported clinical manifestation, is reported. From four separate pharmacologic trials (baclofen, diazepam, levodopa/carbidopa, and trihexyphenidyl), combination baclofen and diazepam therapy was determined to be most efficacious. Opisthotonus and extensor posturing remain only rudimentarily understood. We review the subject and propose a specific mechanism relating our patient's anatomic and physiologic conditions.
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Affiliation(s)
- W G Ondo
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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38
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Liu JC, Ciacci JD, George TM. Brainstem tethering in Dandy-Walker syndrome: a complication of cystoperitoneal shunting. Case report. J Neurosurg 1995; 83:1072-4. [PMID: 7490623 DOI: 10.3171/jns.1995.83.6.1072] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Treatment of the Dandy-Walker syndrome has included placement of a ventriculoperitoneal shunt alone or in combination with a posterior fossa cystoperitoneal shunt. Complications in shunting are common and are usually related to malfunction or infection. The authors present a case in which the patient developed headaches and focal cranial nerve deficits following infection caused by a cystoperitoneal shunt. Magnetic resonance imaging showed tethering of the brainstem. A posterior fossa craniotomy with microsurgical untethering and cyst fenestration achieved two goals: improvement of the focal cranial nerve deficits and elimination of the cystoperitoneal shunt.
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Affiliation(s)
- J C Liu
- Division of Pediatric Neurosurgery, Children's Memorial Hospital, Chicago, Illinois, USA
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39
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Cone AM. Head injury in an adult with previously undiagnosed Dandy-Walker syndrome: a review of the condition and discussion of its anaesthetic implications. Anaesth Intensive Care 1995; 23:613-5. [PMID: 8787265 DOI: 10.1177/0310057x9502300516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A M Cone
- Shackleton Department of Anaesthetics, Southampton General Hospital, United Kingdom
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40
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Abstract
An uncommon but well-recognized occurrence in patients with Dandy-Walker malformation is sudden unexpected death. The mechanism of demise has not been established. We report three patients with Dandy-Walker malformation that experienced sudden unexpected death without uncal or tonsillar herniation, the mechanism usually proposed for demise in such situations. Our findings suggest the possibility of vascular compromise as the cause of the sudden unexpected death in these patients. Early and effective relief of the pressure in the posterior fossa may prevent the occurrence of this catastrophic complication.
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Affiliation(s)
- R D Elterman
- Dallas Pediatric Neurology Associates, Dallas Hospital, TX 75243-1708, USA
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41
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Engelhard HH, Meyer JR. Adult-onset presentation of Dandy-Walker variant in siblings. SURGICAL NEUROLOGY 1995; 44:43-7. [PMID: 7482253 DOI: 10.1016/0090-3019(95)00127-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Dandy-Walker syndrome and Dandy-Walker variant usually present as isolated cases of hydrocephalus in pediatric patients. METHODS AND RESULTS THis paper consists of a case report of the adult onset of symptoms in two sisters having Dandy-Walker variant. Such an occurrence has never before been reported in the medical literature. Both patients presented with headaches and progressive neurologic deficit. On computed tomography (CT scan) of the head, both were found to have hydrocephalus, with hypoplasia of the inferior vermis. Both patients were treated successfully with ventriculoperitoneal shunting. A third sister, with a similar history, elected not to undergo CT scanning or surgical treatment. CONCLUSIONS Variants of the Dandy-Walker syndrome may occasionally present clinically in the adult age group. Such an occurrence in siblings is consistent with an underlying genetic etiology.
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Affiliation(s)
- H H Engelhard
- Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA
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42
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Rasgon N, Ananth J, Mena I, Krout B, Boone K. Agenesis of corpus callosum and dementia of the Alzheimer's type: a review and case report. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1994; 39:429-32. [PMID: 7987785 DOI: 10.1177/070674379403900707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper describes a previously sufficiently functioning 57 year old man who presented with a recent onset of frontal behaviour. Partial agenesis of corpus callosum was an incidental finding on a computerized tomography scan. The EEG was within normal limits and neuropsychological testing did not reveal any interhemispheric disconnection. A SPECT-Scan revealed bilateral hypoperfusion, consistent with Alzheimer's dementia. Normal functioning up to 50 years of age and a later manifestation of Alzheimer's disease along with agenesis of carpus callosum is of clinical interest as such an association has not been published.
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Affiliation(s)
- N Rasgon
- Harbor-UCLA Medical Center, Torrance
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43
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Koyama K, Mori K, Fukushima K. Anesthetic management of a neonate with Dandy-Walker syndrome. J Anesth 1994; 8:344-5. [PMID: 23568125 DOI: 10.1007/bf02514663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/1993] [Accepted: 12/09/1993] [Indexed: 11/26/2022]
Affiliation(s)
- K Koyama
- Department of Anesthesiology, General Ota Hospital, 29-5, Yahata-cho, 373, Ota, Gunma, Japan
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Gorlin RJ, Kantaputra P, Aughton DJ, Mulliken JB. Marked female predilection in some syndromes associated with facial hemangiomas. AMERICAN JOURNAL OF MEDICAL GENETICS 1994; 52:130-5. [PMID: 7801997 DOI: 10.1002/ajmg.1320520203] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Analysis of the literature yielded 42 examples of the combination of sternal non-union and supraumbilical raphé without evidence of sex predilection. However, among an additional 31 cases in which the triad included facial hemangioma, there was almost exclusive female occurrence. Another condition involves extensive unilateral hemangioma of the face, absence of ipsilateral carotid and vertebral vessels, mental retardation, and Dandy-Walker malformation. Still another disorder has been proposed which includes facial hemangioma and dilatation of the carotid syphon. Both of these conditions exhibit marked female predilection. Examples of overlap of all three "disorders" cause the authors to question the independence of these disorders, hypothesizing instead that they represent a spectrum.
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Affiliation(s)
- R J Gorlin
- Department of Oral Science, School of Dentistry, University of Minnesota, Minneapolis 55455
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Abstract
This is a report of a 18 year-old woman with two consecutive fetuses suffering from a Dandy-Walker malformation (DWM). The first diagnosis of Dandy-Walker syndrome was at 24 weeks gestation. According to the parent's request, this pregnancy was terminated. Seven months after that event a new case of Dandy-walker malformation was diagnosed in the same woman. She was at 21 weeks of gestation.
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Affiliation(s)
- R Obwegeser
- Department of Prenatal Diagnosis and Therapy, University of Vienna, Austria
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Schiffmann R, Mannheim GB, Stafstrom CE, Hamburger SD, Holmes GL. Posterior fossa abnormalities in children with infantile spasms. J Child Neurol 1993; 8:360-5. [PMID: 7693798 DOI: 10.1177/088307389300800413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to explore possible pathophysiologic involvement of the brain stem in infantile spasms, we retrospectively compared clinical and electroencephalographic (EEG) features of 14 children with infantile spasms who had gross posterior fossa abnormalities on neuroimaging studies with 84 children with infantile spasms who had either normal neuroimaging (n = 19) or supratentorial abnormalities (n = 65). Children with posterior fossa abnormalities how lower mean initial and follow-up developmental quotients compared to those with normal imaging or supratentorial abnormalities alone. Age of onset of infantile spasms, latency to treatment, response to steroids, and follow-up EEG pattern were not significantly different among the three groups. Six children (6%) had Dandy-Walker cysts, an association rarely reported with infantile spasms. We conclude that the presence of posterior fossa abnormalities in patients with infantile spasms portends a relatively poor developmental outcome.
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Affiliation(s)
- R Schiffmann
- Pediatric Neurology Unit, Hadassah University Hospital, Jerusalem, Israel
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Kingston HM, Nicolini U, Haslam J, Andrews T. 46,XY/47,XY, + 17p + mosaicism in amniocytes associated with fetal abnormalities despite normal fetal blood karyotype. Prenat Diagn 1993; 13:637-42. [PMID: 8415429 DOI: 10.1002/pd.1970130715] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
46,XY/47,XY, + 17p + mosaicism was found in two primary amniotic fluid cultures (AFCs). Fetal blood karyotype was normal, but ultrasonography revealed Dandy-Walker malformation and bilateral choroid plexus cysts. Following termination of pregnancy, fetal examination revealed post-axial polydactyly and neuroblastoma-in-situ affecting both adrenals in addition to the cerebellar abnormalities. Mosaicism for the aberrant cell line was confirmed in all fetal tissues sampled and in the placenta.
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Affiliation(s)
- H M Kingston
- Regional Genetics Centre, St Mary's Hospital, Manchester, U.K
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48
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Abstract
Two children were identified with facial haemangioma, cerebellar hypoplasia and co-arctation of the aorta; the second child presented to the neurology department because of facial haemangioma. The importance of awareness of the association of these three conditions is essential to ensure proper management and survival of this group of patients. The possible pathophysiology of these associated conditions is discussed.
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Affiliation(s)
- W H Goh
- University Paediatric Unit, Queen Mary Hospital, Hong Kong
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Reese V, Frieden IJ, Paller AS, Esterly NB, Ferriero D, Levy ML, Lucky AW, Gellis SE, Siegfried EC. Association of facial hemangiomas with Dandy-Walker and other posterior fossa malformations. J Pediatr 1993; 122:379-84. [PMID: 8441091 DOI: 10.1016/s0022-3476(05)83420-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cutaneous hemangiomas are common benign tumors of infancy that only rarely are associated with malformations in other tissues or organs. We report nine infants with large facial hemangiomas who also had Dandy-Walker malformations or similar posterior fossa abnormalities. On the basis of the experience with our patients and with those previously reported, we recommend radiographic imaging studies of the brain of infants with large, aggressive facial hemangiomas to rule out posterior fossa defects.
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Affiliation(s)
- V Reese
- Department of Dermatology, University of California, San Francisco
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50
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Abstract
The Dandy-Walker syndrome can be accurately diagnosed in utero by sonographic demonstration of characteristic morphologic changes in the fetal posterior fossa. Three cases of Dandy-Walker syndrome are described. The associated intracranial and extracranial anomalies are reviewed, and the value of antenatal diagnosis is discussed.
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Affiliation(s)
- E Cornford
- Department of Radiology, Queen's Medical Centre, Nottingham
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