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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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Samman RS, Gomaa MK, Sheikh BY. Dandy-Walker malformation associated with subarachnoid hemorrhage. A case report. Int J Surg Case Rep 2024; 114:109148. [PMID: 38113564 PMCID: PMC10767204 DOI: 10.1016/j.ijscr.2023.109148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Dandy-Walker malformation is a rare congenital brain defect characterized by vermian agenesia with cystic dilatation of the fourth ventricle, and posterior fossa enlargement. The etiology is still poorly understood but is presupposed to be multifactorial, infrequently caused by intracranial hemorrhage. We describe a case of male newborn known to have Dandy-Walker malformation associated with subarachnoid bleeding after the delivery, which is a quiet rare presentation only discussed in a few literatures before. CASE PRESENTATION We present a rare case of a full-term male baby delivered vaginally, who was diagnosed with Dandy-Walker malformation during antenatal anomaly scan. At birth, the baby presented with a weak cry, cyanosis, respiratory distress and seizure. Post-delivery computed tomography scan revealed subarachnoid hemorrhage. In addition, a hydrocephalus was noted on the imaging and treated with ventriculoperitoneal shunt insertion with marked improvement of the posterior fossa cyst and the hydrocephalus as an outcome of early intervention. DISCUSSION Few literature studies showed an association between intracranial bleeding during early fetal life and the development of Dandy-Walker malformation as it affects the posterior fossa components growth. However, our case highlights on an unusual presentation of the spontaneous subarachnoid hemorrhage after the delivery in a full-term baby diagnosed with Dandy-Walker malformation earlier. CONCLUSION This report highlights the importance of early recognition and implementing appropriate management of the hydrocephalus that associated with intracerebral bleeding to prevent the complications of high intracranial pressure plus brainstem herniation and achieve the best possible outcome.
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Affiliation(s)
- Razan S Samman
- College of Medicine, Taibah University, Almadinah Almunawara, Saudi Arabia
| | - Mohamed K Gomaa
- Department of Pediatrics, Ministry of the National Guard-Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Almadinah Almunawara, Saudi Arabia
| | - Bassem Y Sheikh
- Department of Neurosurgery, Ministry of the National Guard-Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Almadinah Almunawara, Saudi Arabia.
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Alves CAPF, Sidpra J, Manteghinejad A, Sudhakar S, Massey FV, Aldinger KA, Haldipur P, Lucato LT, Ferraciolli SF, Teixeira SR, Öztekin Ö, Bhattacharya D, Taranath A, Prabhu SP, Mirsky DM, Andronikou S, Millen KJ, Barkovich AJ, Boltshauser E, Dobyns WB, Barkovich MJ, Whitehead MT, Mankad K. Dandy-Walker Phenotype with Brainstem Involvement: 2 Distinct Subgroups with Different Prognosis. AJNR Am J Neuroradiol 2023; 44:1201-1207. [PMID: 37591769 PMCID: PMC10549954 DOI: 10.3174/ajnr.a7967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND PURPOSE Although cardinal imaging features for the diagnostic criteria of the Dandy-Walker phenotype have been recently defined, there is a large range of unreported malformations among these patients. The brainstem, in particular, deserves careful attention because malformations in this region have potentially important implications for clinical outcomes. In this article, we offer detailed information on the association of brainstem dysgenesis in a large, multicentric cohort of patients with the Dandy-Walker phenotype, defining different subtypes of involvement and their potential clinical impact. MATERIALS AND METHODS In this established multicenter cohort of 329 patients with the Dandy-Walker phenotype, we include and retrospectively review the MR imaging studies and clinical records of 73 subjects with additional brainstem malformations. Detailed evaluation of the different patterns of brainstem involvement and their potential clinical implications, along with comparisons between posterior fossa measurements for the diagnosis of the Dandy-Walker phenotype, was performed among the different subgroups of patients with brainstem involvement. RESULTS There were 2 major forms of brainstem involvement in patients with Dandy-Walker phenotype including the following: 1) the mild form with anteroposterior disproportions of the brainstem structures "only" (57/73; 78%), most frequently with pontine hypoplasia (44/57; 77%), and 2) the severe form with patients with tegmental dysplasia with folding, bumps, and/or clefts (16/73; 22%). Patients with severe forms of brainstem malformation had significantly increased rates of massive ventriculomegaly, additional malformations involving the corpus callosum and gray matter, and interhemispheric cysts. Clinically, patients with the severe form had significantly increased rates of bulbar dysfunction, seizures, and mortality. CONCLUSIONS Additional brainstem malformations in patients with the Dandy-Walker phenotype can be divided into 2 major subgroups: mild and severe. The severe form, though less prevalent, has characteristic imaging features, including tegmental folding, bumps, and clefts, and is directly associated with a more severe clinical presentation and increased mortality.
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Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - J Sidpra
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
- Developmental Biology & Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - A Manteghinejad
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - S Sudhakar
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
| | - F V Massey
- Unit of Functional Neurosurgery (F.V.M.), National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - K A Aldinger
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - P Haldipur
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - L T Lucato
- Department of Radiology, Division of Neuroradiology (L.T.L., S.F.F.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S F Ferraciolli
- Department of Radiology, Division of Neuroradiology (L.T.L., S.F.F.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S R Teixeira
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - Ö Öztekin
- Department of Neuroradiology (Ö.Ö.), Bakırçay University, Çiğli Education and Research Hospital, İzmir, Turkey
| | - D Bhattacharya
- Department of Neuroradiology (D.B.), Royal Victoria Hospital, Belfast, UK
| | - A Taranath
- Department of Medical Imaging (A.T.), Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - S P Prabhu
- Department of Radiology, Neuroradiology Division (S.P.P.), Boston Children's Hospital, Boston, Massachusetts
| | - D M Mirsky
- Department of Radiology, Neuroradiology Division (D.M.M.), Children's Hospital Colorado, Aurora, Colorado
| | - S Andronikou
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - K J Millen
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - A J Barkovich
- Department of Neuroradiology (A.J.B., M.J.B.), University of California, San Francisco, San Francisco, California
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital, Zürich, Switzerland
| | - W B Dobyns
- Department of Genetics and Metabolism (W.B.D.), University of Minnesota, Minneaplis, Minnesota
| | - M J Barkovich
- Department of Neuroradiology (A.J.B., M.J.B.), University of California, San Francisco, San Francisco, California
| | - M T Whitehead
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - K Mankad
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
- Developmental Biology & Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Guida L, Benichi S, Bourgeois M, Paternoster G, James S, De Saint Denis T, Dangouloff Ros V, Beccaria K, Blauwblomme T. The Management of Hydrocephalus in Midline Posterior Fossa Cystic Collections: Surgical Outcome From a Retrospective Single-Center Case Series of 54 Consecutive Pediatric Patients. Neurosurgery 2023; 93:576-585. [PMID: 36921245 DOI: 10.1227/neu.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/13/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Hydrocephalus frequently occurs with midline posterior fossa cystic collections. The classification of this heterogeneous group of developmental anomalies, including Dandy-Walker malformation, persisting Blake's pouch, retrocerebellar arachnoid cysts, and mega cisterna magna, is subject of debate. The absence of diagnostic criteria is confusing regarding the ideal management of PFCC-related hydrocephalus. OBJECTIVE To decipher the surgical strategy for the treatment of children with PFCC-related hydrocephalus through a retrospective analysis of the surgical outcome driven by their clinical and radiological presentation. METHODS This study enrolled patients operated of symptomatic PFCC-related hydrocephalus. Clinical and MRI features were examined, as well as the surgical outcome. Unbiased subgroup classification of the patients was performed with multiple component analysis as a function of imaging characteristics and hierarchical clustering on principal component. Outcome was assessed with binomial logistic regression and Kaplan-Meier analysis. RESULTS Fifty-four patients were included between 2007 and 2021. Multiple component analysis suggested that cerebellar and vermian hypoplasia, vermian rotation, basal-tentorial angle, and fastigial angle were strongly correlated. Hierarchical clustering and the distribution of the patients in the bidimensional plot showed the clear segregation of 3 major clusters, which correlated with the radiological diagnosis ( P < .01). Binomial logistic regression and survival analysis showed that endoscopic third ventriculostomy was an effective treatment for patients with persisting Blake's pouch, while failing to control hydrocephalus in most of patients with Dandy-Walker malformation. CONCLUSION Preoperative MRI in patients with PFCC-related hydrocephalus is essential to better define the diagnosis. The choice of treatment strategy notably relies on correct radiological diagnosis.
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Affiliation(s)
- Lelio Guida
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
| | - Syril James
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
| | | | - Volodia Dangouloff Ros
- Department of Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université Paris Cité, UMR 1163, Institut Imagine, Paris , France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
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Formoso S, Padley H, Alves L. Dandy Walker-like malformation in an adult cat with seizures: clinical description and MRI characteristics. JFMS Open Rep 2023; 9:20551169231174199. [PMID: 37378378 PMCID: PMC10291414 DOI: 10.1177/20551169231174199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/29/2023] Open
Abstract
Case summary A 2-year-old male neutered domestic shorthair cat was referred for investigation of a 10-month history of self-limiting, generalised tonic-clonic seizures. The cat was reported to be normal interictally but had always had a static abnormal gait. General physical examination was unremarkable. Neuroanatomical localisation was compatible with a diffuse cerebellar and diffuse forebrain lesion. Complete blood count, biochemistry, bile acid stimulation test, urinalysis, cisternal cerebrospinal fluid (CSF) analysis, Toxoplasma gondii serology and T gondii polymerase chain reaction in CSF were all unremarkable. MRI revealed an abnormal caudal fossa, absent cerebellar vermis and small cerebellar hemisphere with distension of the fourth ventricle. There were no forebrain abnormalities identified in the MRI or CSF changes that could justify the seizures. Considering the clinical presentation, the cat's neurological examination and MRI features, a presumptive diagnosis of Dandy Walker-like malformation (DWLM) and epilepsy of unknown aetiology was made. Relevance and novel information This is the first case report of an adult cat diagnosed with cerebellar malformation resembling DWLM and concomitant seizures, its MRI characteristics and long-term follow-up. The 3-year follow-up consultation revealed static neurological status with 2-4 seizures per year. The cat's quality of life remained good at the time of writing.
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Affiliation(s)
- Sara Formoso
- Department of Small Animal Medicine, Queen’s Veterinary School Hospital, University of Cambridge, Cambridge, UK
| | - Hannah Padley
- Anderson Moores Veterinary Specialists, Hursley, Hampshire, UK
| | - Lisa Alves
- Department of Small Animal Medicine, Queen’s Veterinary School Hospital, University of Cambridge, Cambridge, UK
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Luo TF, Wang YB, Wang DH, Zhan S, Deng SL. Lateral ventricle pleomorphic xanthoastrocytoma concurrent with Dandy-Walker complex: A case report. Medicine (Baltimore) 2022; 101:e30492. [PMID: 36086683 PMCID: PMC10980463 DOI: 10.1097/md.0000000000030492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Dandy-Walker complex and pleomorphic xanthoastrocytomas are both rare disease entities that typically manifest early in life and are associated with congenital etiological factors. Dandy-Walker complex is a cerebellar malformation associated with a series of anatomical changes. The disease onset is usually at birth or during infancy. Late onset in adulthood is uncommon. Pleomorphic xanthoastrocytoma is a rare WHO grade II astrocytic tumor affecting mainly young adults. Concomitant occurrence of Dandy-Walker complex and pleomorphic xanthoastrocytoma has not been previously reported. PATIENT CONCERNS AND DIAGNOSIS A 30-year-old woman with a previous history of unconfirmed resected lateral ventricle meningioma presented with severe headache for 1 day. Imaging examination revealed a mass in the right lateral ventricle with heterogeneous signal patterns, changes in the posterior fossa corresponding to a Dandy-Walker variant, and mild hydrocephalus. INTERVENTIONS AND OUTCOMES Surgical complete resection of the mass was achieved. postoperative histopathological examination confirmed WHO grade II pleomorphic xanthoastrocytoma. Three years postsurgery, ventriculoperitoneal shunt was performed due to worsening of hydrocephalus. The patient has since remained symptom-free. CONCLUSION This is the first report of concomitant occurrence of Dandy-Walker complex and pleomorphic xanthoastrocytoma. The association of neurological congenital malformation with intracranial neoplasms may be multifactorial, with underlying role of genetic mutations or chromosome alterations.
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Affiliation(s)
- Tian-Fei Luo
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Yu-Bo Wang
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Chang Chun, China
| | - Dan-Hua Wang
- Department of Pathology, First Hospital of Jilin University, Chang Chun, China
| | - Shuang Zhan
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Chang Chun, China
| | - Shuang-Lin Deng
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Chang Chun, China
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Di Nora A, Costanza G, Pizzo F, Di Mari A, Sapuppo A, Basile A, Fiumara A, Pavone P. Dandy-Walker malformation and variants: clinical features and associated anomalies in 28 affected children-a single retrospective study and a review of the literature. Acta Neurol Belg 2022:10.1007/s13760-022-02059-z. [PMID: 36068432 DOI: 10.1007/s13760-022-02059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics, the neuroimaging features and associated anomalies observed in children affected by Dandy-Walker malformations (DWM) and variants (DWV) in a single tertiary hospital in Catania and compare our data to their existent in the literature. METHODS A retrospective case series using the medical records has been performed on 28 children diagnosed with DWM and DWV admitted to a single tertiary section of Pediatric Neurology, Department of Catania, Italy from January 2005 to January 2021. We reviewed the neuroimaging using the new diagnostic criteria of Klein et al. RESULTS: Associated anomalies were frequently reported. Among these, hydrocephalus was found in 13/28 (48%), and hydrocephalus plus corpus callosum anomalies in three children (10%). We described corpus callosum, cardiac and genitourinary anomalies in 2/28 (7%), 3/28 (10%), and 3/28 (10%), respectively. The most common clinical features were the developmental delay and epilepsy observed in 19/28 (67%) and in 9/28 (32%) of the cases. The first exam at the diagnosis was MRI in 17/28 patients, followed by transfontanellar ultrasound in 5/28, computed tomography in 4/28 and prenatal ultrasound in 2/28. To note, a child with DWM was affected by Down syndrome and one by congenital disorders of N-linked glycosylation (CDG-IId). CONCLUSIONS Children with DWV were more commonly observed than children with DWM. Hydrocephalus is an anomaly, frequently and equally reported in both DWM and DMV. Perinatal complications were frequent adverse events with severe respiratory distress and need for cardiopulmonary resuscitation. Cognitive involvement and epilepsy were the most common comorbidities. Single DWV is associated with a better developmental outcome.
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Affiliation(s)
- A Di Nora
- Department of Clinical and Experimental Medicine, University of Catania Postgraduate Training Program in Pediatrics, Catania, Italy.
| | - G Costanza
- Department of Clinical and Experimental Medicine, University of Catania Postgraduate Training Program in Pediatrics, Catania, Italy
| | - F Pizzo
- Department of Clinical and Experimental Medicine, University of Catania Postgraduate Training Program in Pediatrics, Catania, Italy
| | - A Di Mari
- Department of Radiology, University of Catania Postgraduate Training Program in Radiology, Catania, Italy
| | - A Sapuppo
- Department of Pediatric Neurology, University of Catania, Catania, Italy
| | - A Basile
- Radiology Unit, Policlinico G.Rodolico, Catania, Italy, University of Catania, 95123, Catania, Italy
| | - A Fiumara
- Department of Pediatric Neurology, University of Catania, Catania, Italy
| | - P Pavone
- Department of Pediatric Neurology, University of Catania, Catania, Italy
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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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Hernandez NE, Lu VM, Altman N, Ragheb J, Niazi TN, Wang S. Incidence, follow-up, and postnatal clinical progress of children with central nervous system anomalies on fetal MRI. J Neurosurg Pediatr 2022; 30:160-168. [PMID: 35901770 DOI: 10.3171/2022.4.peds2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI is increasingly employed to assess intrauterine fetal anomalies. Central nervous system (CNS) anomalies are common structural conditions that warrant evaluation with fetal MRI and subsequent prenatal consultation with a pediatric neurosurgeon. As the use of fetal MRI increases, there is greater impetus to understand the most common CNS structural anomalies diagnosed in utero, as well as their natural histories. METHODS The authors performed a single-center retrospective review of fetal MRI evaluations performed between January 2012 and December 2020. Children who underwent both prenatal and postnatal neurosurgical evaluations of CNS anomalies were included. Specific CNS anomalies on fetal MRI, associated extra-CNS findings, and suspicion for genetic abnormality or syndromes were noted. Postnatal clinical status and interventions were assessed. RESULTS Between January 2012 and December 2020, a total of 469 fetal MRI evaluations were performed; of these, 114 maternal-fetal pairs had CNS anomalies that warranted prenatal consultation and postnatal pediatric neurosurgical follow-up. This cohort included 67 male infants (59%), with a mean ± SD follow-up of 29.8 ± 25.0 months after birth. Fetal MRI was performed at 27.3 ± 5.8 weeks of gestational age. The most frequently reported CNS abnormalities were ventriculomegaly (57%), agenesis or thinning of the corpus callosum (33%), Dandy-Walker complex (DWC) (21%), neuronal migration disorders (18%), and abnormalities of the septum pellucidum (17%). Twenty-one children (18%) required neurosurgical intervention at a mean age of 2.4 ± 3.7 months. The most common surgical conditions included myelomeningocele, moderate to severe ventriculomegaly, encephalocele, and arachnoid cyst. Corpus callosum agenesis or thinning was associated with developmental delay (p = 0.02) and systemic anomalies (p = 0.05). The majority of prenatal patients referred for DWC had Dandy-Walker variants that did not require surgical intervention. CONCLUSIONS The most common conditions for prenatal neurosurgical assessment were ventriculomegaly, corpus callosum anomaly, and DWC, whereas the most common surgical conditions were myelomeningocele, hydrocephalus, and arachnoid cyst. Only 18% of prenatal neurosurgical consultations resulted in surgical intervention during infancy. The majority of referrals for prenatal mild ventriculomegaly and DWC were not associated with developmental or surgical sequelae. Patients with corpus callosum abnormalities should be concurrently referred to a neurologist for developmental assessments.
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Affiliation(s)
- Nicole E Hernandez
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
| | - Victor M Lu
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Nolan Altman
- 3Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | - John Ragheb
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Toba N Niazi
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Shelly Wang
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
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10
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Akiyama S, Madan N, Graham G, Samura O, Kitano R, Yun HJ, Craig A, Nakamura T, Hozawa A, Grant E, Im K, Tarui T. Regional brain development in fetuses with Dandy-Walker malformation: A volumetric fetal brain magnetic resonance imaging study. PLoS One 2022; 17:e0263535. [PMID: 35202430 PMCID: PMC8870580 DOI: 10.1371/journal.pone.0263535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/20/2022] [Indexed: 11/18/2022] Open
Abstract
Dandy-Walker malformation (DWM) is a common prenatally diagnosed cerebellar malformation, characterized by cystic dilatation of the fourth ventricle, upward rotation of the hypoplastic vermis, and posterior fossa enlargement with torcular elevation. DWM is associated with a broad spectrum of neurodevelopmental abnormalities such as cognitive, motor, and behavioral impairments, which cannot be explained solely by cerebellar malformations. Notably, the pathogenesis of these symptoms remains poorly understood. This study investigated whether fetal structural developmental abnormalities in DWM extended beyond the posterior fossa to the cerebrum even in fetuses without apparent cerebral anomalies. Post-acquisition volumetric fetal magnetic resonance imaging (MRI) analysis was performed in 12 fetuses with DWM and 14 control fetuses. Growth trajectories of the volumes of the cortical plate, subcortical parenchyma, cerebellar hemispheres, and vermis between 18 and 33 weeks of gestation were compared. The median (interquartile range) gestational ages at the time of MRI were 22.4 (19.4-24.0) and 23.9 (20.6-29.2) weeks in the DWM and control groups, respectively (p = 0.269). Eight of the 12 fetuses with DWM presented with associated cerebral anomalies, including hydrocephalus (n = 3), cerebral ventriculomegaly (n = 3), and complete (n = 2) and partial (n = 2) agenesis of the corpus callosum (ACC); 7 presented with extracerebral abnormalities. Chromosomal abnormalities were detected by microarray analysis in 4 of 11 fetuses with DWM, using amniocentesis. Volumetric analysis revealed that the cortical plate was significantly larger in fetuses with DWM than in controls (p = 0.040). Even without ACC, the subcortical parenchyma, whole cerebrum, cerebellar hemispheres, and whole brain were significantly larger in fetuses with DWM (n = 8) than in controls (p = 0.004, 0.025, 0.033, and 0.026, respectively). In conclusion, volumetric fetal MRI analysis demonstrated that the development of DWM extends throughout the brain during the fetal period, even without apparent cerebral anomalies.
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Affiliation(s)
- Shizuko Akiyama
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Neel Madan
- Radiology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - George Graham
- Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Osamu Samura
- Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, Japan
| | - Rie Kitano
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Hyuk Jin Yun
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Alexa Craig
- Pediatric Neurology, Maine Medical Center, Portland, Oregan, United States of America
| | - Tomohiro Nakamura
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Kiho Im
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Tomo Tarui
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts, United States of America
- Pediatric Neurology, Tufts Children’s Hospital, Boston, Massachusetts, United States of America
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11
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Ulrich J, Caird J, Crimmins D. Predicting outcomes in Dandy-Walker malformation: a retrospective cohort study. J Neurosurg Pediatr 2021; 28:710-715. [PMID: 34507295 DOI: 10.3171/2021.5.peds21140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dandy-Walker malformation (DWM) is a disorder that most neurologists and neurosurgeons will manage at some point during their careers. It is characterized by partial or complete dysgenesis of the cerebellar vermis. Outcomes are highly variable and range from functionally normal to severely disabled. Predicting these outcomes has classically been focused on the radiological findings that constitute DWM. Other anomalies that can be commonly found in these patients are potentially more indicative of outcome than the tenet markers of DWM. Furthermore, hydrocephalus is an ever-present danger in these patients, many of whom will be admitted to the hospital due to this condition. This study aims to identify these items as potential predictors of outcome. METHODS All referrals from antenatal anatomy scans between 1992 and 2013 that were suspicious for DWM were reviewed. Neurosurgery archives were reviewed for outpatient letters and other correspondence. The number of DWM diagnoses was quantified. Outcomes were judged based on patient status, ranging from death to attending normal school. The presence of any other anomalies was quantified and measured against patient outcomes. RESULTS Cyst size and the presence of another CNS anomaly were shown to portend worse outcomes. Non-CNS anomalies and hydrocephalus were not predictive of worse outcomes. Furthermore, of all the treatments assessed, ventriculoperitoneal shunts were shown to be the most effective in this data set. CONCLUSIONS Results from this study suggest a pivot in how prognoses in DWM should be established and how parents should be counseled, along with a view of hydrocephalus and its treatment that challenges the current literature.
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Affiliation(s)
- James Ulrich
- 1Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - John Caird
- 2Department of Neurosurgery, Temple Street Children's University Hospital, Dublin; and
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12
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Sandoval Karamian AG, Mercimek-Andrews S, Mohammad K, Molloy EJ, Chang T, Chau V, Murray DM, Wusthoff CJ. Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy. Semin Fetal Neonatal Med 2021; 26:101272. [PMID: 34417137 DOI: 10.1016/j.siny.2021.101272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying cause of encephalopathy has important treatment implications. This review outlines conditions that cause NE and may be mistaken for HIE, along with their distinguishing clinical features, pathophysiology, investigations, and treatments. NE due to brain malformations, vascular causes, neuromuscular causes, genetic conditions, neurogenetic disorders and inborn errors of metabolism, central nervous system (CNS) and systemic infections, and toxic/metabolic disturbances are discussed.
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Affiliation(s)
- A G Sandoval Karamian
- Children's Hospital of Philadelphia, Division of Neurology, 3501 Civic Center Blvd Office 1200.12, Philadelphia, PA, 19104, USA.
| | - S Mercimek-Andrews
- Biochemical Geneticist, Department of Medical Genetics, University of Alberta, 8-39 Medical Sciences Building, 8613 - 144 Street, Edmonton, T6G 2H7, Alberta, Canada.
| | - K Mohammad
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.
| | - E J Molloy
- Trinity College, the University of Dublin, Trinity Translational Medicine Institute, Dublin, Ireland; Children's Health Ireland at Tallaght and Crumlin & and Coombe Women's and Infants University Hospital, Dublin, Ireland; Trinity Research in Childhood Centre (TRiCC), Trinity Academic Centre, Tallaght University Hospital, Dublin 24, Ireland.
| | - T Chang
- George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA; Neonatal Neurology Program, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Vann Chau
- Neurology, Neonatal Neurology Program, The Hospital for Sick Children, 555 University Avenue, Toronto ON, M5G 1X8, Canada.
| | - D M Murray
- Deptartment of Paediatric and Child Health, University College Cork, ARm 2.32, Paediatric Academic Unit, Floor 2, Seahorse Unit, Cork University Hospital, Wilton, Cork, T12 DCA4, Ireland.
| | - Courtney J Wusthoff
- Division of Child Neurology, Division of Pediatrics- Neonatal and Developmental Medicine, Stanford Children's Health, 750 Welch Road, Suite 317, Palo Alto, CA, 94304 USA.
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13
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Severe symptomatic hyponatremia due to cerebral salt wasting syndrome in a patient with traumatic head injury and Dandy-Walker malformation of the brain. Clin Nephrol Case Stud 2021; 9:4-10. [PMID: 33633924 PMCID: PMC7901359 DOI: 10.5414/cncs110146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Cerebral salt wasting (CSW) is an uncommon cause of hyponatremia characterized by extracellular volume depletion, high urine sodium concentration and osmolality, and low serum uric acid concentration in association with central nervous system (CNS) disease. Distinguishing CSW from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), a much more common form of hyponatremia in this setting, can be challenging because both present with identical laboratory features. However, treatment of CSW and SIADH differs, making a correct diagnosis important. Here we present a case of CSW in a 75-year-old man in whom severe hyponatremia and volume depletion were discovered in the setting of traumatic head injury and Dandy-Walker malformation of the brain, a rare congenital brain malformation. Treatment with intravenous normal saline and later oral salt supplementation and fludrocortisone was successful.
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14
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Belser-Ehrlich J, Lafo JA, Mangal P, Bradley M, Wicklund M, Bowers D. Neurocognitive profile of a man with Dandy-Walker malformation: Evidence of subtle cerebellar cognitive affective syndrome. Clin Neuropsychol 2020; 34:591-610. [PMID: 30821610 PMCID: PMC6717685 DOI: 10.1080/13854046.2019.1569724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 01/08/2023]
Abstract
Background: The Dandy-Walker Malformation (DWM) is a congenital birth malformation that is characterized by a triad of features: cerebellar dysgenesis, cystic dilation of the fourth ventricle, and an enlarged posterior fossa that displaces the dural sinuses and the tentorium. Despite this defining triad, clinical presentation can be highly heterogeneous in part due to severity of structural changes. To date, there been limited consideration of cognitive-behavioral symptoms of DWM in relation to nonmotor functions of the cerebellum, specifically cerebellar cognitive affective syndrome (CCAS).Method: In this case study, we describe the neuropsychological and behavioral profile of a 48-year-old man with DWM who was seen due to concerns, expressed solely by the patient's father, about his son's atypical housing, employment and social skills.Results: Neuropsychological test findings revealed high average intellect on standard intellectual measures (WAIS-IV), with stronger verbal (superior) than perceptual reasoning (average) skills. Across all cognitive domains, performance was generally within expectations, although bilateral fine motor skills were impaired. In contrast, he exhibited weaknesses on nontraditional neuropsychological measures assessing orbitofrontal-limbic circuitry, including reward sensitivity decision making and indices of threat-related emotional physiology.Conclusions: Through the use of traditional and nontraditional neuropsychological measures, subtle cognitive weaknesses in fronto-executive and affective regulation were illuminated and likely explain the patient's functional difficulties. Etiologically, these findings are consistent with the nonmotor functions of the cerebellum as described by CCAS.
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Affiliation(s)
| | | | - Paul Mangal
- Department of Clinical and Health Psychology, University of Florida
| | | | | | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida
- Department of Neurology, University of Florida
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15
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Klebe D, McBride D, Krafft PR, Flores JJ, Tang J, Zhang JH. Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: Established mechanisms and proposed pathways. J Neurosci Res 2020; 98:105-120. [PMID: 30793349 PMCID: PMC6703985 DOI: 10.1002/jnr.24394] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/05/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023]
Abstract
In addition to being the leading cause of morbidity and mortality in premature infants, germinal matrix hemorrhage (GMH) is also the leading cause of acquired infantile hydrocephalus. The pathophysiology of posthemorrhagic hydrocephalus (PHH) development after GMH is complex and vaguely understood, although evidence suggests fibrosis and gliosis in the periventricular and subarachnoid spaces disrupts normal cerebrospinal fluid (CSF) dynamics. Theories explaining general hydrocephalus etiology have substantially evolved from the original bulk flow theory developed by Dr. Dandy over a century ago. Current clinical and experimental evidence supports a new hydrodynamic theory for hydrocephalus development involving redistribution of vascular pulsations and disruption of Starling forces in the brain microcirculation. In this review, we discuss CSF flow dynamics, history and development of theoretical hydrocephalus pathophysiology, and GMH epidemiology and etiology as it relates to PHH development. We highlight known mechanisms and propose new avenues that will further elucidate GMH pathophysiology, specifically related to hydrocephalus.
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Affiliation(s)
- Damon Klebe
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Devin McBride
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Paul R Krafft
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Jerry J Flores
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Jiping Tang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
- Department of Anesthesiology and Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92350
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16
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Pfeifer CM, Willard SD, Cornejo P. MRI depiction of fetal brain abnormalities. Acta Radiol Open 2019; 8:2058460119894987. [PMID: 31903224 PMCID: PMC6927204 DOI: 10.1177/2058460119894987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022] Open
Abstract
Intracranial abnormalities are commonly suspected findings on antenatal ultrasound that require evaluation by magnetic resonance imaging. This review depicts multiple abnormalities imaged as a means to guide clinicians in proper diagnosis.
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Affiliation(s)
- Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott D Willard
- Department of Radiology, Nemours Children's Health System, Jacksonville, FL, USA
| | - Patricia Cornejo
- Department of Medical Imaging, Phoenix Children's Hospital, Phoenix, AZ, USA
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17
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Chrystal PW, Walter MA. Aniridia and Axenfeld-Rieger Syndrome: Clinical presentations, molecular genetics and current/emerging therapies. Exp Eye Res 2019; 189:107815. [PMID: 31560925 DOI: 10.1016/j.exer.2019.107815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/11/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
Aniridia and Axenfeld-Rieger Syndrome are related, human ocular disorders that are typically inherited in an autosomal dominant manner. Both result from incorrect development of the eye and have, as their most serious consequences, elevated risk to develop the blinding condition glaucoma. This review will focus on describing the clinical presentations of Aniridia and Axenfeld-Rieger Syndrome as well as the molecular genetics and current and emerging therapies used to treat patients.
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Affiliation(s)
- Paul W Chrystal
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Michael A Walter
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada.
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18
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Khan A, Kurtz B, Ambardekar A. Lessons Learned From a Burn-Injured Pediatric Patient With Dandy-Walker Syndrome After Multiple Anesthetics: A Case Report. A A Pract 2019; 13:166-168. [PMID: 30985318 DOI: 10.1213/xaa.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dandy-Walker syndrome is a rare congenital brain malformation that requires unique anesthetic considerations. We present a rare case of an 18-month-old boy with Dandy-Walker syndrome presenting with 17% total body surface area burns undergoing multiple general anesthetics for both operative and bedside procedures. Numerous lessons were learned during multiple anesthetics, which influenced and guided our subsequent anesthetic management. The preoperative assessment, risk for respiratory apnea, opioid management, risk for laryngospasm, and postoperative care of patients with Dandy-Walker syndrome were all lessons learned.
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Affiliation(s)
- Asif Khan
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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19
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Miura I, Aihara Y, Mitsuyama T, Chiba K, Nakano H, Kawamata T. Basilar invagination in a child with atlanto-occipital subluxation and suspected prenatal Dandy-Walker malformation. Childs Nerv Syst 2019; 35:1429-1434. [PMID: 31101983 DOI: 10.1007/s00381-019-04164-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Although advances in imaging have allowed earlier and more accurate diagnosis of various fetal anomalies, Dandy-Walker malformation (DWM) remains one of the more challenging central nervous system anomalies to diagnose accurately before birth. Basilar invagination (BI), which is a dislocation of the dens in an upward direction, is occasionally accompanied by Klippel-Feil syndrome (KFS). We report a pediatric case of BI caused by atlanto-occipital subluxation (AOS) in KFS, suspected of having DWM prenatally but head magnetic resonance images (MRI) showed no evidence of that at 7 months of age. CASE At 28 weeks of gestation, fetal MRI study revealed a small cerebellar vermis, leading us to suspect a DWM. The patient was born at 40 weeks of gestation. Head CT showed inferior vermian hypoplasia without findings of hydrocephalus. Cervicothoracic CT showed cervical lamina assimilations, thoracic hemivertebrae, and cervicothoracic scoliosis. He was diagnosed with Dandy-Walker variant and KFS. At 7 months of age, head MRI showed near normal cerebellum and vermis and there was no evidence of the DWM. He did not have intellectual or developmental delay and imaging studies were performed periodically. At 9 years of age, an already existing cough headache deteriorated. Three-dimensional reconstructed images from CT scan showed C1 hypoplasia, fusion of C1 and C2, BI, and AOS. Sagittal T2-weighted MRI showed protrusion of cerebellar tonsils inferiorly to the level of the posterior arch of C2. Serum calcium, phosphate, and parathyroid hormone levels were normal. The diagnosis was tonsillar herniation related to BI following AOS in KFS. Posterior occipitocervical fixation was performed under traction. CONCLUSIONS We found out two important clinical issues: DWM findings after birth can be disappearing and BI can present sequential deterioration because of AOS in KFS. Our observation indicated the possible prognosis of pediatric BI with long follow-up and can help us decide on its surgical treatment timing when associated with AOS.
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Affiliation(s)
- Isamu Miura
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yasuo Aihara
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Tetsuryu Mitsuyama
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kentaro Chiba
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroshi Nakano
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
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20
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Zhang N, Qi Z, Zhang X, Zhong F, Yao H, Xu X, Liu J, Huang Y. Dandy-Walker syndrome associated with syringomyelia in an adult: a case report and literature review. J Int Med Res 2019; 47:1771-1777. [PMID: 30799663 PMCID: PMC6460593 DOI: 10.1177/0300060518808961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dandy-Walker syndrome associated with syringomyelia is a rare condition, with few reports of adult cases. We describe an adult case of Dandy-Walker syndrome with concomitant syringomyelia. A 33-year-old man presented with a 3-month history of walking instability, numbness in the hands, memory deterioration, and urinary incontinence. A physical examination showed a positive Romberg sign. Brain computed tomography and magnetic resonance imaging showed hydrocephalus, a cyst in the posterior fossa, absence of the cerebellar vermis, hypoplasia of the corpus callosum and cerebella, and syringomyelia. All of these symptoms were consistent with the diagnosis of Dandy-Walker syndrome. Surgery involving arachnoid adhesiolysis and endoscopic third ventriculostomy was performed. At the 6-month follow-up, the symptoms were completely relieved. Magnetic resonance imaging showed that syringomyelia was greatly reduced and the hydrocephalus remained unchanged. Dandy-Walker syndrome with concomitant syringomyelia in adults is exceedingly rare. Early diagnosis and appropriate surgical treatment of this condition should be highlighted. Combined arachnoid adhesiolysis and endoscopic third ventriculostomy may be an effective approach.
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Affiliation(s)
- Nan Zhang
- 1 Department of Neurosurgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhenyu Qi
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
| | - Xuewen Zhang
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
| | - Fangping Zhong
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
| | - Hui Yao
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
| | - Xiang Xu
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
| | - Jiangang Liu
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
| | - Yulun Huang
- 2 Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, Suzhou, China
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21
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Rajput R, Mishra S, Ahlawat P, Yadav PK. Dandy-Walker variant with precocious puberty: a rare association. BMJ Case Rep 2018; 11:11/1/e226281. [DOI: 10.1136/bcr-2018-226281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Precocious puberty is characterised by premature appearance of secondary sexual characteristics before the age of 7 years in girls and 9 years in boys. Dandy-Walker malformation comprises a spectrum of intracranial malformations of the posterior fossa. We present a case of a 7-year-old male child who has presented with features of central precocious puberty and on further evaluation has been found to have Dandy-Walker variant and secondary hypothyroidism. The following case report describes this association which is extremely rare and has never been described in literature.
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22
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Dovjak GO, Brugger PC, Gruber GM, Song JW, Weber M, Langs G, Bettelheim D, Prayer D, Kasprian G. Prenatal assessment of cerebellar vermian lobulation: fetal MRI with 3-Tesla postmortem validation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:623-630. [PMID: 28782259 DOI: 10.1002/uog.18826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To optimize the imaging assessment of fetal hindbrain malformations, this observational magnetic resonance imaging (MRI) study aimed to assess whether fetal vermian lobulation can be quantified accurately and whether the relative growth of vermian lobules is uniform. METHODS This retrospective study included singleton fetuses which underwent T2-weighted MRI in vivo with a 1.5-Tesla (T) scanner or within 24 h postmortem with a 3-T scanner between January 2007 and November 2016 at the Medical University of Vienna. We included only those showing normal structural brain development on ultrasound and MRI and which had image quality appropriate for quantitative analysis, i.e. good image quality and a precise midsagittal slice. Fetal brains were segmented and, for all discernible vermian lobules, we determined the mean relative area contribution (MRAC, the proportion of the lobule relative to the total vermian area, in terms of number of voxels). Inter- and intrarater measurement variability of a representative selection (21 cases) was determined by intraclass correlation coefficient (ICC) for voxel-based differences. A linear regression model was used to assess the correlation between the relative size of each vermian lobule (i.e. MRAC) and gestational age. RESULTS A total of 78 fetuses scanned in vivo aged 18-32 gestational weeks and seven fetuses scanned postmortem aged 16-30 weeks had a precise midsagittal slice and image quality sufficient for quantitative analysis. After 22 weeks of gestation, seven of the nine known vermian lobules could be discriminated reliably. The MRAC showed a mean ± SD difference of only 2.89 ± 3.01% between in-vivo and postmortem measurements. The ICC of voxel-based interrater differences was mean ± SD, 0.91 ± 0.05 and the intrarater ICC was 0.95 ± 0.03. Growth of cerebellar lobules was non-uniform: the MRAC of culmen and DFT (declive + folium + tuber) increased with gestational age, whereas that of lingula, centralis, pyramis and nodulus decreased. The growth of the uvula showed no significant correlation with gestational age. CONCLUSIONS Fetal vermian lobulation can be assessed accurately and reliably after 22 weeks on precise midsagittal sequences with 1.5-T T2-weighted MRI. Fetal vermian lobules show non-uniform growth, with expansion of DFT and culmen at the expense of the other vermian lobules. Evaluation and elucidation of vermian lobulation in normal fetuses should enable better characterization of fetuses with hindbrain malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G O Dovjak
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - P C Brugger
- Center for Anatomy and Cell Biology, Department of Anatomy, Medical University of Vienna, Vienna, Austria
| | - G M Gruber
- Center for Anatomy and Cell Biology, Department of Anatomy, Medical University of Vienna, Vienna, Austria
| | - J W Song
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, CT, USA
| | - M Weber
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - G Langs
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - D Bettelheim
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - G Kasprian
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
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Sufianov AA, Kasper EM, Sufianov RA. An optimized technique of endoscopic third ventriculocisternostomy (ETV) for children with occlusive hydrocephalus. Neurosurg Rev 2017; 41:851-859. [PMID: 29230595 DOI: 10.1007/s10143-017-0934-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
In this article, we present an optimized minimally invasive technique of ETV for children with occlusive hydrocephalus. The study comprises of 64 consecutive pediatric cases (34 boys and 30 girls aged from 1 month to 5 years) of occlusive hydrocephalus from various etiologies, which were treated with a modified technique of ETV. Mean clinical follow-up period after ETV was 24.2 ± 3.8 months. Application of the new technique made it possible to significantly reduce the length of the soft tissue incision for access, and the use of upgraded instruments allowed to perform a twist drill hole in the skull to less than half a usual size. Access to the brain and lateral ventricle was performed by blunt trephination of the dura without the need for significant corticectomy or coagulation, and yielded minimal damage to the brain, which is very important in patients of young age. Continued endoscopic control during the approach down to the lateral ventricle increases safety and decreases risk of injury, and can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle. Mortality in our cohort was 0%, and there were no postoperative neurological, endocrinological, or infectious complications. Patency rates of the first ETV performed was 78%, with the remaining patients requiring additional surgical procedures for complicated settings. This new technique of minimally invasive ETV placement in pediatric patients is an effective and safe method to treat occlusive hydrocephalus and can be recommended for extensive clinical use.
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Affiliation(s)
- Albert Akramovich Sufianov
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation (city of Tyumen), Ul. 4 km. Chervishevskogo trakta, 5, Tyumen, 625032, Russia. .,I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st, Moscow, 119991, Russia.
| | - Ekkehard M Kasper
- Department of Neurosurgery, Harvard Medical School, A-111, 25 Shattuck Street, Boston, 02115, MA, USA.,Division of Neurosurgery, Beth Israel Deaconess Medical Center, 110, Francis Street - Suite 3B, Boston, MA, 02215, USA
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Young B, Foster A, McKelvie P. Paediatric Salzmann's nodular degeneration in Dandy-Walker syndrome variant. Clin Exp Ophthalmol 2017; 46:567-569. [PMID: 29165863 DOI: 10.1111/ceo.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Braden Young
- Ophthalmology Department, Caloundra Hospital, Caloundra, Queensland, Australia
| | - Andrew Foster
- Ophthalmology Department, Caloundra Hospital, Caloundra, Queensland, Australia
| | - Penelope McKelvie
- Ophthalmology Department, Caloundra Hospital, Caloundra, Queensland, Australia
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BATMAZ M, BALÇIK ZE, ÖZER Ü, HAMURİŞÇİ YALÇIN B, ÖZEN Ş. Dandy-Walker Malformation Presenting with Affective Symptoms. Noro Psikiyatr Ars 2017; 54:277-281. [PMID: 29033643 PMCID: PMC5630109 DOI: 10.5152/npa.2017.18114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Dandy-Walker malformation is defined by enlarged posterior fossa, cystic dilatation of the fourth ventricle, and cerebellar hypoplasia. Although developmental delay and mental retardation are common in Dandy-Walker malformation cases, other comorbid psychiatric conditions have been rarely reported. There are limited numbers of case reports about comorbidity of bipolar disorder with Dandy-Walker malformation in the literature. Herein, a Dandy-Walker malformation case presenting affective symptoms is reported, and psychiatric symptoms which might be seen in this rare malformation are discussed along with diagnosis, treatment, and follow-up processes. A 27-year-old male patient, hospitalized for compulsory treatment, had been diagnosed with Dandy-Walker malformation in childhood. First complaints were attention deficiency, behavioral problems, learning difficulties; and manic and depressive episodes have occurred during follow-ups. He recently complained of decreased need for sleep, irritability, and increased speed of thought, and psychiatric examination was consistent with manic episode. Cranial computed tomography (CT) revealed bilateral ventriculomegaly, enlarged third and fourth ventricles with posterior fossa cyst, and cerebellar hypoplasia. His treatment included 30 mg/day aripiprazole, 1000 mg/day valproic acid, 200 mg/day quetiapine, 4 mg/day biperiden, and 100 mg/month paliperidone palmitate. Beside its traditional role in the regulation of coordination and motor functions, cerebellum is increasingly emphasized for its involvement in the mood regulation. Thus, as seen in Dandy-Walker malformation, cerebellar anomalies are suggested to play a role in the pathophysiology of mood disorders. Further studies are needed to better understand the relationship between mood disorders and cerebellum. Moreover, treatment options should be considered carefully in terms of resistance to treatment and potential side effects, for psychiatric disorders occurring in these cases; and detailed examinations, including cranial imaging, would be beneficial in bipolar cases with early onset, unresponsiveness to treatment, presenting atypical symptoms, mental retardation, and developmental delay as well as neurological symptoms and signs.
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Affiliation(s)
- Mert BATMAZ
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Ezgi BALÇIK
- Department of Neurology, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Ürün ÖZER
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Burcu HAMURİŞÇİ YALÇIN
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Şakir ÖZEN
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
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Venturini E, Magni L, Pucci G, Mazzinghi F. A late presentation of Dandy–Walker malformation and aortic coarctation. J Cardiovasc Med (Hagerstown) 2017; 18:381-384. [DOI: 10.2459/jcm.0b013e3283356ebe] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Syringomyelia caused by an arachnoid web in a patient with shunted Dandy-Walker malformation. Childs Nerv Syst 2017; 33:665-670. [PMID: 27822765 DOI: 10.1007/s00381-016-3293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Dandy-Walker malformation (DWM) is a congenital brain anomaly characterized by dysgenesis of the cerebellar vermis and the presence of a posterior fossa cyst. The association of syringomyelia with DWM is extremely rare. CASE REPORT A 10-year-old patient who was diagnosed with DWM in infancy presented with progressive scoliosis and fecal incontinence. He had been treated with cystoventriculoperitoneal shunting with a Y-connection during infancy, which was followed by a revision 6 years later. During the revision surgery, intraventricular bleeding occurred and was managed conservatively. Imaging studies for the current visit revealed syringomyelia along the cervicothoracic spinal cord and a membranous structure around the cervicomedullary junction. Phase-contrast cine magnetic resonance imaging (MRI) revealed disturbed cerebrospinal fluid (CSF) flow across the membrane. We excised the arachnoid web that was tethering the brainstem and blocking CSF flow. Postoperatively, the patient experienced symptom relief, and the follow-up imaging study demonstrated a dramatic decrease in the size of the syringomyelia. DISCUSSION We suggest that syrinx formation in this patient was possibly caused by disturbed CSF flow and tethering of the brainstem. CONCLUSION We experienced an unusual case of DWM with syringomyelia which was caused by an arachnoid web blocking CSF flow and tethering the brainstem. The arachnoid web seems to be formed by previous bleeding which occurred at the time of shunt revision. After excision of the arachnoid web, the patient showed good outcome.
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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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Abstract
The cerebellum has long been recognized for its role in motor co-ordination, but it is also increasingly appreciated for its role in complex cognitive behavior. Historically, the cerebellum has been overwhelmingly understudied compared to the neocortex in both humans and model organisms. However, this tide is changing as advances in neuroimaging, neuropathology, and neurogenetics have led to clinical classification and gene identification for numerous developmental disorders that impact cerebellar structure and function associated with significant overall neurodevelopmental dysfunction. Given the broad range in prognosis and associated medical and neurodevelopmental concerns accompanying cerebellar malformations, a working knowledge of these disorders and their causes is critical for obstetricians, perinatologists, and neonatologists. Here we present an update on the genetic causes for cerebellar malformations that can be recognized by neuroimaging and clinical characteristics during the prenatal and postnatal periods.
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Tomà P, Magnano GM, Martinoli C. Ecotomografia delle malformazioni congenite del sistema nervoso centrale. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/19714009900030s106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In questo lavoro, sulla base della nuova classificazione di Van der Knapp e Valk, sono state trattate le malformazioni congenite del Sistema Nervoso Centrale diagnosticabili nel feto e nel neonato con l'ecotomografia. Particolare attenzione è stata rivolta alla precisa caratterizzazione semeiologica di ciascuna malformazione nel tentativo di puntualizzare gli elementi necessari per una corretta diagnosi differenziale ecotomografica.
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Affiliation(s)
- P. Tomà
- Servizio di Radiologia, Istituto G. Gaslini, Genova
| | | | - C. Martinoli
- Servizio di Radiologia, Istituto G. Gaslini, Genova
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Abstract
Le malformazioni cistiche della fossa cranica posteriore comprendono: il complesso di Dandy-Walker e le cisti aracnoidee. All'interno del cosiddetto complesso di Dandy-Walker vengono poi classificate: la malformazione di Dandy-Walker (MDW) verae propria, la Dandy-Walker variante (DWV) e la megacisterna magna (MCM). Il complesso di Dandy-Walker sarebbe costituito da malformazioni cistiche della fossa posteriore che da un punto di vista embriogenetico rappresenterebbero un continuum dalle forme più complesse (MDW) alle forme meno gravi (MCM). Esse raggruppano anomalie di sviluppo variamente associate del verme, della tela corioidea, dello spazio subaracnoideo retro-cerebello-bulbare e delle strutture durali, strutture che si formano e si posizionano simultaneamente tra la VII e la X settimana di vita fetale. La definizione della MDW include classicamente: una agenesia parziale o completa del verme associata ad ipoplasia degli emisferi cerebellari, una dilatazione cistica del IV ventricolo e una espansione della fossa posteriore associata ad alta inserzione del tentorio, del torculare di Erofilo e dei seni trasversi. Nella DWV esistono molte somiglianze anatomiche con la MDW, tuttavia l'elemento cardine nella distinzione fra le due e una rotazione del verme meno accentuata rispetto alia MDW. La MCM è un'anomala dilatazione della cisterna magna che comunica liberamente con il sistema ventricolare e gli spazi subaracnoidei in assenza di grossolane alterazioni del cervelletto. Da un punto di vista anatomo-patologico rappresenta una evaginazione della tela corioidea del IV ventricolo. Infine le cisti aracnoidee della fossa cranica posteriore sono formazioni a contenuto liquorale che si sviluppano nel contesto della membrana aracnoidea. Essa rappresenta quindi una entità diversa da un punto di vista anatomo-patologico dal continuum delle malformazioni del complesso di Dandy-Walker anche se difficile può essere la diagnosi differenziale fra MCM e cisti aracnoidea quando quest'ultima è posta nella stessa sede della MCM.
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Naidich T, Braffman B, Altman N, Birchansky S. Malformations of the Posterior Fossa and Craniovertebral Junction. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099400700309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T.P. Naidich
- TPN Department of Radiology Baptist Hospital of Miami, BHB Department of Radiology, Memorial Hospital; Hollywood FL, NA & SBB Department of Radiology, Miami Children's Hospital
| | - B. Braffman
- TPN Department of Radiology Baptist Hospital of Miami, BHB Department of Radiology, Memorial Hospital; Hollywood FL, NA & SBB Department of Radiology, Miami Children's Hospital
| | - N.R. Altman
- TPN Department of Radiology Baptist Hospital of Miami, BHB Department of Radiology, Memorial Hospital; Hollywood FL, NA & SBB Department of Radiology, Miami Children's Hospital
| | - S.B. Birchansky
- TPN Department of Radiology Baptist Hospital of Miami, BHB Department of Radiology, Memorial Hospital; Hollywood FL, NA & SBB Department of Radiology, Miami Children's Hospital
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Resta M, Spagnolo P, Di Cuonzo F, Palma M, Florio C, Greco P, D'Addario V, Vimercati A, Selvaggi L, Caruso G, Clemente R. La risonanza magnetica del feto. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099400700402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vengono riportati i quadri patologici osservati in 27 RM fetali prenatali e catalogati in sezioni. Nella sezione riguardante l'anencefalia e la microcefalia sono discussi rispettivamente un caso di anencefalia classica, una microcefalia vera di Evrard, una microcefalia semplice associata a malformazioni in altri apparati ed una rara osservazione di iniencefalia. Nella sezione delle oloprosencefalie sono riportate due oloprosencefalie alobari e due oloprosencefalie semilobari. Nella sezione della agenesia del corpo calloso, sono illustrati 5 casi di agenesia totale, 2 casi isolati, e 3 associati ad altre anomalie del sistema nervoso. Una cisti in tensione del setto pellucido è stata arbitrariamente inserita in quest'ultima sezione. Fra i complessi di Dandy-Walker sono enumerate una malformazione classica di Dandy-Walker, 2 Dandy-Walker variant ed una megacisterna magna. Le anomalie di Chiari riscontrate sono state 2 e si riferiscono entrambe ad una condizione a tipo Chiari I, associata ad idrocefalo in un caso, ad agenesia del corpo calloso nell'altro. In un ultima sezione vengono presentati 2 casi di moderata idrocefalia e due casi di cospicua idrocefalia. Vengono infine presentate alcune brevi considerazioni conclusive sulla validità della metodica.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - R. Clemente
- Istituto di Anatomia Patologica; Policlinico, Università di Bari
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Kitova T, Kitov B, Zhelyazkov H, Milkov D, Chelli D, Masmoudi A, Gaigi S. A fetopathological and clinical study of the Dandy-Walker malformation and a literature review. CASE REPORTS IN PERINATAL MEDICINE 2016. [DOI: 10.1515/crpm-2015-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim: The Dandy-Walker malformation is a rare abnormality of the central nervous system pertaining to the group of cystic malformations. The frequency of occurrence of the malformation ranges from 1:800 to 35,000 live births. The aim of this study is to investigate the Dandy-Walker malformation in two cases – one by autopsy after abortion due to medical indications during the 25th gestational week at The Clinic of Embryo and Fetopathology, Center for Maternity and Neonatology, Tunis, Tunisia, and another case of a 1-year-old infant diagnosed with an acute internal hydrocephalus at The Clinic of Neurosurgery, Medical University Plovdiv, Bulgaria, and to compare the results with those in the literature.
Results: Both cases are of an isolated Dandy-Walker malformation without any associated abnormalities of the central nervous system and other organs and systems. After the placement of a ventriculoperitoneal shunt in the second case, the child’s condition was greatly improved.
Conclusion: The question arises whether the prenatal diagnosis of an isolated Dandy-Walker malformation is an indication for pregnancy termination, and who and after what examinations has the right to make this decision, given the favorable outcome after surgical treatment.
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Affiliation(s)
- Tanya Kitova
- Department of Anatomy, Histology and Embryology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Borislav Kitov
- Department and Clinic of Neurosurgery, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Hristo Zhelyazkov
- Department and Clinic of Neurosurgery, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Denis Milkov
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Dalenda Chelli
- Department of Obstetrics and Gynecology, Center for Maternity and Neonatology, Tunis, Tunisia
| | - Aida Masmoudi
- Clinic of Embryo and Fetopathology, Center for Maternity and Neonatology, Tunis, Tunisia
| | - Soumeya Gaigi
- Clinic of Embryo and Fetopathology, Center for Maternity and Neonatology, Tunis, Tunisia
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Cignini P, Giorlandino M, Brutti P, Mangiafico L, Aloisi A, Giorlandino C. Reference Charts for Fetal Cerebellar Vermis Height: A Prospective Cross-Sectional Study of 10605 Fetuses. PLoS One 2016; 11:e0147528. [PMID: 26812238 PMCID: PMC4727931 DOI: 10.1371/journal.pone.0147528] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/27/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To establish reference charts for fetal cerebellar vermis height in an unselected population. METHODS A prospective cross-sectional study between September 2009 and December 2014 was carried out at ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy. Of 25203 fetal biometric measurements, 12167 (48%) measurements of the cerebellar vermis were available. After excluding 1562 (12.8%) measurements, a total of 10605 (87.2%) fetuses were considered and analyzed once only. Parametric and nonparametric quantile regression models were used for the statistical analysis. In order to evaluate the robustness of the proposed reference charts regarding various distributional assumptions on the ultrasound measurements at hand, we compared the gestational age-specific reference curves we produced through the statistical methods used. Normal mean height based on parametric and nonparametric methods were defined for each week of gestation and the regression equation expressing the height of the cerebellar vermis as a function of gestational age was calculated. Finally the correlation between dimension/gestation was measured. RESULTS The mean height of the cerebellar vermis was 12.7mm (SD, 1.6mm; 95% confidence interval, 12.7-12.8mm). The regression equation expressing the height of the CV as a function of the gestational age was: height (mm) = -4.85+0.78 x gestational age. The correlation between dimension/gestation was expressed by the coefficient r = 0.87. CONCLUSION This is the first prospective cross-sectional study on fetal cerebellar vermis biometry with such a large sample size reported in literature. It is a detailed statistical survey and contains new centile-based reference charts for fetal height of cerebellar vermis measurements.
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Affiliation(s)
- Pietro Cignini
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| | - Maurizio Giorlandino
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| | - Pierpaolo Brutti
- Department of Statistics, Sapienza University of Rome, Rome, Italy
| | - Lucia Mangiafico
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
| | - Alessia Aloisi
- Department of Obstetrics and Gynecology, Campus Biomedico University of Rome, Rome, Italy
| | - Claudio Giorlandino
- Department of Prenatal Diagnosis, ALTAMEDICA Fetal-Maternal Medical Centre, Rome, Italy
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The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions. Neurol Res Int 2015; 2015:794829. [PMID: 26770824 PMCID: PMC4681798 DOI: 10.1155/2015/794829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/07/2015] [Accepted: 09/17/2015] [Indexed: 02/07/2023] Open
Abstract
The craniocervical junction (CCJ) is a potential choke point for craniospinal hydrodynamics and may play a causative or contributory role in the pathogenesis and progression of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, MS, and ALS, as well as many other neurological conditions including hydrocephalus, idiopathic intracranial hypertension, migraines, seizures, silent-strokes, affective disorders, schizophrenia, and psychosis. The purpose of this paper is to provide an overview of the critical role of the CCJ in craniospinal hydrodynamics and to stimulate further research that may lead to new approaches for the prevention and treatment of the above neurodegenerative and neurological conditions.
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Idrocefalo nei bambini e negli adulti. Neurologia 2015. [DOI: 10.1016/s1634-7072(15)73994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Reduction cranioplasty for macrocephaly improves patients' quality of life both functionally and aesthetically. However, it is indicated for only a small number of patients because of the risks of complications. Thus, it is rarely performed, and not many reports have been published. In Dandy-Walker syndrome, there is often a posterior fossa cyst continuous with the fourth ventricle. We report here a case of scaphocephalic macrocephaly because of such a cystic lesion. The patient underwent a single-stage surgery with plication of the cyst wall and posterior reduction cranioplasty. This procedure achieved good results.
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McClelland S, Ukwuoma OI, Lunos S, Okuyemi KS. Mortality of Dandy-Walker syndrome in the United States: Analysis by race, gender, and insurance status. J Neurosci Rural Pract 2015; 6:182-5. [PMID: 25883477 PMCID: PMC4387808 DOI: 10.4103/0976-3147.153224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dandy-Walker syndrome (DWS) is a congenital disorder often diagnosed in early childhood. Typically manifesting with signs/symptoms of increased intracranial pressure, DWS is catastrophic unless timely neurosurgical care can be administered via cerebrospinal fluid (CSF) drainage. The rates of mortality, adverse discharge disposition (ADD), and CSF drainage in DWS may not be uniform regardless of race, gender or insurance status; such differences could reflect disparities in access to neurosurgical care. This study examines these issues on a nationwide level. MATERIALS AND METHODS The Kids' Inpatient Database spanning 1997-2003 was used for analysis. Only patients admitted for DWS (ICD-9-CM = 742.3) were included. Multivariate analysis was adjusted for several variables, including patient age, race, sex, admission type, primary payer, income, and hospital volume. RESULTS More than 14,000 DWS patients were included. Increasing age predicted reduced mortality (OR = 0.87; P < 0.05), ADD (OR = 0.96; P < 0.05), and decreased likelihood of receiving CSF drainage (OR = 0.86; P < 0.0001). Elective admission type predicted reduced mortality (OR = 0.29; P = 0.0008), ADD (OR = 0.68; P < 0.05), and increased CSF drainage (OR = 2.02; P < 0.0001). African-American race (OR = 1.20; P < 0.05) and private insurance (OR = 1.18; P < 0.05) each predicted increased likelihood of receiving CSF drainage, but were not predictors of mortality or ADD. Gender, income, and hospital volume were not significant predictors of DWS outcome. CONCLUSION Increasing age and elective admissions each decrease mortality and ADD associated with DWS. African-American race and private insurance status increase access to CSF drainage. These findings contradict previous literature citing African-American race as a risk factor for mortality in DWS, and emphasize the role of private insurance in obtaining access to potentially lifesaving operative care.
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Affiliation(s)
- Shearwood McClelland
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Onyinyechi I Ukwuoma
- Department of Pediatrics, Brookdale University Hospital and Medical Center, New York, USA
| | - Scott Lunos
- Biostatistics Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA ; Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Shohoud SA, Azab WA, Alsheikh TM, Hegazy RM. Blake's pouch cyst and Werdnig-Hoffmann disease: Report of a new association and review of the literature. Surg Neurol Int 2014; 5:S282-8. [PMID: 25225621 PMCID: PMC4163908 DOI: 10.4103/2152-7806.139390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/19/2014] [Indexed: 12/26/2022] Open
Abstract
Background: We report a case of a neonate with proximal spinal muscular atrophy (SMA) type 1 (also known as Werdnig-Hoffmann disease or severe infantile acute SMA) associated with a Blake's pouch cyst; a malformation that is currently classified within the spectrum of Dandy-Walker complex. The association of the two conditions has not been previously reported in the English literature. A comprehensive review of the pertinent literature is presented. Case Description: A male neonate was noted to have paucity of movement of the four limbs with difficulty of breathing and poor feeding soon after birth. Respiratory distress with tachypnea, necessitated endotracheal intubation and mechanical ventilation. Pregnancy was uneventful except for decreased fetal movements reported by the mother during the third trimester. Neurological examination revealed generalized hypotonia with decreased muscle power of all limbs, nonelicitable deep tendon jerks, and occasional tongue fasciculations. Molecular genetic evaluation revealed a homozygous deletion of both exons 7 and 8 of the survival motor neuron 1 (SMN1) gene, and exon 5 of the neuronal apoptosis inhibitory protein (NAIP) gene on the long arm of chromosome 5 consistent with Werdnig-Hoffmann disease (SMA type 1). At the age of 5 months, a full anterior fontanelle and abnormal increase of the occipito-frontal circumference were noted. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) of the brain revealed a tetraventricular hydrocephalus and features of Blake's pouch cyst of the fourth ventricle. Conclusions: This case represents a previously unreported association of Blake's pouch cyst and SMA type 1.
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Affiliation(s)
- Sherien A Shohoud
- Neonatal Intensive Care Unit, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Waleed A Azab
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Tarek M Alsheikh
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Rania M Hegazy
- Department of Diagnostic Radiology, Jahra Hospital, Kuwait City, Kuwait
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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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Selmin A, Foltran F, Chiarelli S, Ciullo R, Gregori D. An epidemiological study investigating the relationship between chorangioma and infantile hemangioma. Pathol Res Pract 2014; 210:548-53. [PMID: 24836731 DOI: 10.1016/j.prp.2014.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 04/08/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to verify whether the infantile hemangioma (IH) incidence in children whose placentas showed a chorangioma is higher than in the general population, thus addressing the hypothesized relationship between chorangioma and IH. METHODS All chorangioma diagnoses by the 1st Service of Pathology, University of Padova in 2004-2010, based on the analysis of placentas sent by the Department of Gynecological Sciences and Human Reproduction (University of Padova), were identified. Demographic, anamnestic and clinical data were collected from the mothers and newborns; mothers and pediatricians were interviewed by telephone within 1 year after birth to verify if any IH appeared. The incidence rates of IH and other adverse events (IUGR, preterm delivery, cesarean section, stillbirth) were compared with national and regional data, when available, or with estimates from the scientific literature. RESULTS Thirty-eight chorangioma diagnoses were found. Of 33 infants born with a placenta affected by chorangioma, 18 infants had IH. The IH incidence recorded in our series (55%) was significantly higher than that recorded in national and regional surveys and in the scientific literature. Similar findings have been observed for the incidence of stillbirth, preterm birth and low birth weight incidence. CONCLUSIONS The IH incidence observed in our series appears to be significantly higher than that recorded among the general population, suggesting that an association between placental chorangioma and IH could exist which should be further verified in prospective studies.
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Affiliation(s)
- Alessia Selmin
- Department for Women and Neonatal Care, Abano Terme General Hospital, Abano, PD, Italy
| | - Francesca Foltran
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | | | - Rosaria Ciullo
- Department for Mother and Pediatric Care, Obstetrics and Gynecology Clinic, A.O. 2, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
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Covert orienting in three etiologies of congenital hydrocephalus: the effect of midbrain and posterior fossa dysmorphology. J Int Neuropsychol Soc 2014; 20:268-77. [PMID: 24528548 DOI: 10.1017/s1355617713001501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Covert orienting is related to the integrity of the midbrain, but the specificity of the relation is unclear. We compared covert orienting in three etiologies of congenital hydrocephalus (aqueductal stenosis [AS], Dandy-Walker malformation [DWM], and spina bifida myelomeningocele [SBM]--with and without tectal beaking) to explore the effects of midbrain and posterior fossa malformations. We hypothesized a stepwise order of group performance reflecting the degree of midbrain tectum dysmorphology. Performance on an exogenously cued covert orienting task was compared using repeated measures analysis of covariance, controlling for age. Individuals with SBM and tectal beaking demonstrated the greatest disengagement cost in the vertical plane, whereas individuals with AS performed as well as a typically developing (TD) group. Individuals with SBM but no tectal beaking and individuals with DWM showed greater disengagement costs in the vertical plane relative to the TD group, but better performance relative to the group with SBM and tectal beaking. Individuals with AS, DWM, and SBM and tectal beaking demonstrated poorer inhibition of return than TD individuals. Impairments in attentional disengagement in SBM are not attributable to the general effects of hydrocephalus, but are instead associated with specific midbrain anomalies that are part of the Chiari II malformation.
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Robinson AJ. Inferior vermian hypoplasia--preconception, misconception. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:123-136. [PMID: 24497418 DOI: 10.1002/uog.13296] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ashley J Robinson
- Department of Radiology, Children's Hospital of British Columbia, 4480 Oak Street, Vancouver, V6H 3V4, Canada.
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Cinalli G, Cappabianca P, de Falco R, Spennato P, Cianciulli E, Cavallo LM, Esposito F, Ruggiero C, Maggi G, de Divitiis E. Current state and future development of intracranial neuroendoscopic surgery. Expert Rev Med Devices 2014; 2:351-73. [PMID: 16288598 DOI: 10.1586/17434440.2.3.351] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the introduction of the modern, smaller endoscopes in the 1960s, neuroendoscopy has become an expanding field of neurosurgery. Neuroendoscopy reflects the tendency of modern neurosurgery to aim towards minimalism; that is, access and visualization through the narrowest practical corridor and maximum effective action at the target point with minimal disruption of normal tissue. Transventricular neuroendoscopy allows the treatment of several pathologies inside the ventricular system, such as obstructive hydrocephalus and intra-/paraventricular tumors or cysts, often avoiding the implantation of extracranial shunts or more invasive craniotomic approaches. Endoscopic endonasal transphenoidal surgery allows the treatment of pathologies of the sellar and parasellar region, with the advantage of a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences and reduced complications. However, an endoscope may be used to assist microsurgery in virtually any kind of neurosurgical procedures (endoscope-assisted microsurgery), particularly in aneurysm and tumor surgery. Basic principles of optical imaging and the physics of optic fibers are discussed, focusing on the neuroendoscope. The three main chapters of neuroendoscopy (transventricular, endonasal transphenoidal and endoscope-assisted microsurgery) are reviewed, concerning operative instruments, surgical procedures, main indications and results.
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Affiliation(s)
- Giuseppe Cinalli
- Santobono Children's Hospital, Via Gennaro Serra n.75, 80132 Naples, Italy.
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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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