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Firouzabadi FD, Soldatelli MD, Rameh V, Heidary G, Vargas SO, Gonzalez E, Rispoli J, Rahbar R, Robson CD. Morning Glory Disc Anomaly: Expanding the MR Phenotype. AJNR Am J Neuroradiol 2024; 45:1070-1075. [PMID: 38991766 DOI: 10.3174/ajnr.a8296] [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: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND PURPOSE Morning glory disc anomaly (MGDA) is a congenital malformation characterized by a funnel-shaped optic disc excavation with radiating vessels and a central glial tuft. Imaging is essential to evaluate associated cephalocele and steno-occlusive vasculopathy. The goal of this study was to assess optic nerve, chiasmatic, and sphenoid bone morphology in MGDA. MATERIALS AND METHODS This retrospective study examined all subjects with funduscopically confirmed MGDA diagnosed and imaged with brain MR imaging between 2008 and 2023. RESULTS Thirty-two children met inclusion criteria. Ocular involvement was unilateral in 29 subjects and bilateral in 3. Segmental optic nerve enlargement ipsilateral to the MGDA was seen in 21 subjects, with 3 also demonstrating a segmental reduction in the size of the ipsilateral optic nerve. Segmental reduction in the size of the ipsilateral optic nerve was present in 3 additional subjects, one with bilateral MGDA. The optic chiasm appeared asymmetrically thickened in 21 subjects, often with deformity. The optic nerves appeared normal in signal intensity in all subjects, with faint peripheral chiasmatic enhancement in 4 of 20 patients who received contrast. Optic nerve findings were stable in 15 subjects with multiple examinations. A persistent craniopharyngeal canal was identified in 17 subjects with sphenoid cephalocele in 1 and mild inferior pituitary gland displacement in 4. Tubular or nodular nasopharyngeal lesions were seen in 10 subjects. One subject had an off-midline sphenoid bone cleft, midbrain deformity, and abnormal thickening of and enhancement around the left oculomotor nerve; the oculomotor nerve finding was present in 1 additional patient. CONCLUSIONS MGDA often manifests with ipsilateral optic nerve thickening, leading to a potential misdiagnosis as optic glioma. MGDA is also commonly associated with a persistent craniopharyngeal canal with variable pituitary gland and infundibular deformity, cephalocele, and tubular or nodular nasopharyngeal lesions.
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Affiliation(s)
- F D Firouzabadi
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Radiology and Biomedical Engineering (F.D.F.), University of San Francisco School of Medicine, San Francisco, California
| | - M D Soldatelli
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - V Rameh
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - G Heidary
- Department of Ophthalmology (G.H., E.G.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - S O Vargas
- Department of Pathology (S.O.V.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - E Gonzalez
- Department of Ophthalmology (G.H., E.G.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Rispoli
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - R Rahbar
- Department of Otolaryngology (R.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Communication Enhancement, (R.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - C D Robson
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Gerrie SK, Rajani H, Branson HM, Lyons CJ, Marie E, Frayn CS, Hughes ECM, Navarro OM. Pediatric orbital lesions: ocular pathologies. Pediatr Radiol 2024; 54:876-896. [PMID: 38321238 DOI: 10.1007/s00247-024-05869-w] [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: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.
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Affiliation(s)
- Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher J Lyons
- Department of Ophthalmology, BC Children's Hospital, Vancouver, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Oscar M Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Persisting embryonal infundibular recess (PEIR) and transsphenoidal-transsellar encephaloceles: distinct entities or constituents of one continuum? Childs Nerv Syst 2022; 38:1059-1067. [PMID: 35192025 DOI: 10.1007/s00381-022-05467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
Persisting embryonal infundibular recess (PEIR) is a very rare anomaly of the floor of the third ventricle in which the embryonic morphology of the infundibular recess (IR) persists. The exact underlying mechanism of development of PEIR is unknown, and the anomaly has been reported as an isolated finding or in association with other conditions. On the other hand, trans-sphenoidal encephaloceles are the rarest form of basal encephaloceles. The trans-sphenoidal trans-sellar encephalocele (TSE) is the least common variant in which the pituitary gland, pituitary stalk, optic pathways, parts of the third ventricle and IR may be present within the encephalocele. We recently treated one patient with TSE. Based on the observed morphological similarity of the IR in our patient and in the published cases of PEIR, we reviewed the literature in order to validate the hypothesis that PEIR and TSE may possibly belong to one spectrum of malformations. Across the published reports, the morphology of the IR in TSE is very closely similar to PEIR. Moreover, radiological, patho-anatomical, and embryological evidence is in support to our hypothesis that PEIR and TSE are most likely the two extremes of the same continuum of malformations.
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Zou Y, She K, Hu Y, Ren J, Fei P, Xu Y, Peng J, Zhao P. Clinical and Echographic Features of Morning Glory Disc Anomaly in Children: A Retrospective Study of 249 Chinese Patients. Front Med (Lausanne) 2022; 8:800623. [PMID: 35141246 PMCID: PMC8818885 DOI: 10.3389/fmed.2021.800623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To report the clinical and echographic features, the prevalence of retinal detachment (RD), and associated visual acuity in a cohort of pediatric patients with morning glory disc anomaly (MGDA). Methods This was a retrospective review of 249 pediatric patients with MGDA (271 eyes) seen at the Dept. of Ophthalmology, Xinhua Hospital. Their medical records were reviewed for demographic data and ocular and systemic findings. The maximal depth and width of the cavity were measured using standardized echographic images. The ratios of cavitary depth to axial length, cavitary depth to maximal cavitary width, and the product of cavitary depth and width were calculated and used to indicate the relative size of the excavation. The clinical and echographic findings were correlated with visual acuity and the occurrence of RD of the patient. Results The relative size of the excavation and the presence of RD were positively associated with increased risk of poor vision (p < 0.05). The presence of persistent fetal vasculature was not associated with the risk of RD and poor vision. The ratio of cavitary depth to axial length more than or equal to 0.25 conferred an increased risk of RD (OR, 2.101; 95% CI, 1.469–3.003). Conclusions Clinical and echographic features of MGDA may be used in predicting the risk of RD. Measuring the relative size of excavation via echography may guide the follow-ups and assist in the early diagnosis of RD.
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Affiliation(s)
- Yihua Zou
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiqin She
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqian Hu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianing Ren
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fei
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jie Peng
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Peiquan Zhao
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A rare triad of morning glory disc anomaly, moyamoya vasculopathy, and transsphenoidal cephalocele: pathophysiological considerations and surgical management. Neurol Sci 2021; 42:5433-5439. [PMID: 33825116 PMCID: PMC8642253 DOI: 10.1007/s10072-021-05221-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
Morning glory disc anomaly is a congenital abnormality of the optic disc and peripapillary retina reported as an isolated condition or associated with various anomalies, including basal encephaloceles and moyamoya vasculopathy. However, the co-occurrence of these three entities is extremely rare and the pathogenesis is still poorly understood. Moreover, data on the surgical management and long-term follow-up of the intracranial anomalies are scarce. Here, we describe the case of a 11-year-old boy with morning glory disc anomaly, transsphenoidal cephalocele, and moyamoya vasculopathy, who underwent bilateral indirect revascularization with encephalo-duro-myo-arterio-pericranio-synangiosis at the age of 2 years, and endoscopic repair of the transsphenoidal cephalocele at the age of 6 years. A rare missense variant (c.1081T>C,p.Tyr361His) was found in OFD1, a gene responsible for a X-linked ciliopathy, the oral-facial-digital syndrome type 1 (OFD1; OMIM 311200). This case expands the complex phenotype of OFD1 syndrome and suggests a possible involvement of OFD1 gene and Shh pathway in the pathogenesis of these anomalies.
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