Our clinical observations noted an interhemispheric "cyst," a protrusion of the posterior superior third ventricle, in fetuses with myelomeningocele (MMC). The study analyzed the frequency of this observation and features that influence its visualization.
We searched for cases of fetal MMC sonographically detected between 1999 and 2007. Intracranial findings were retrospectively reviewed with attention to the interhemispheric cistern. Additionally, we reviewed 25 fetuses without a central nervous system anomaly and 10 fetuses with ventriculomegaly but no MMC.
Among 89 fetuses identified, the mean gestational age was 22 weeks 4 days. Thirty-eight (43%) had an interhemispheric cyst. The frequency was similar on sonograms judged to be well visualized compared with studies judged to be suboptimally visualized. The degree of ventriculomegaly, timing of diagnosis, and severity of the Chiari II malformation did not appear to influence the frequency of the finding. Among fetuses without a central nervous system anomaly, no interhemispheric cysts were detected; a cyst was detected in 1 of 10 fetuses with ventriculomegaly. Interhemispheric cysts were more likely to be detected in fetuses with the Chiari II malformation than fetuses with ventriculomegaly but without the Chiari II malformation (P = .04).
Interhemispheric cysts are a common supratentorial feature of the Chiari II malformation. Their presence appears to be unrelated to other features of the Chiari II malformation. Although interhemispheric cysts are seen in other abnormal fetuses, their striking prevalence in the Chiari II malformation should lead to a thorough examination for MMC.
[Show abstract][Hide abstract] ABSTRACT: Ultrasound finding of the 'tulip sign' has been described as "unique sonographic picture of hypospadias". In some special conditions, if a fetus with spina bifida or a complex malformation which includes spina bifida, sits in breech presentation, this finding could indicate a neurogenic incontinence, like in our case. The autors assumed that in this case, the ventral flexion of the penis was the result of the neurogenically induced atony of the penis and the gravitational force.
Gynaecologia et Perinatologia 06/2010; 19(2):97-100.
[Show abstract][Hide abstract] ABSTRACT: An up-to-date, evidence-based review of the neurosurgical literature reveals that clinical outcomes following the operative management of Chiari I and II malformations have improved dramatically since these congenital disorders were first recognized as surgical diseases. A detailed assessment of major measurable postoperative parameters, including improvement in clinical signs and symptoms, resolution of syringomyelia, and progression of scoliosis, proves these procedures to be safe and effective when performed in a timely manner by an experienced neurosurgeon. Patients with CM-I routinely report a significant reduction in headache, neck pain, apnea, and syrinx-related symptoms and encounter low rates of complication or reoperation after posterior fossa decompression using a bone-only or intradural approach. Neonates and infants with CM-II have higher rates of symptomatic improvement and reversal of impairment when an operative intervention is made at the first sign of brainstem dysfunction. The current trend of less invasive bone-only surgical approaches, if shown in larger prospective trials to be superior to traditional decompressions with dural opening, will only add to the modern-day neurosurgeon’s ability to achieve excellent clinical outcomes with minimal risk in the treatment of patients with Chiari I and II malformations.
The Chiari Malformations, 01/2013: pages 333-344; , ISBN: 978-1-4614-6368-9
[Show abstract][Hide abstract] ABSTRACT: The cerebellum shares many neuroanatomical, histochemical and neurophysiological features with other CNS structures and many generic processes affecting the cerebellum will exhibit similar imaging features as seen in supratentorial and brainstem regions. The cerebellum also has many particular features that are reflected in its selective involvement by multiple pathological processes with characteristic imaging features. The purpose of this chapter is to provide the reader with a general overview and differential diagnosis of the pathological processes involving the cerebellum with similar imaging features as seen in other CNS structures as well as describing particular conditions more selectively involving the cerebellum with more specific radiological appearance.
Handbook of the Cerebellum and Cerebellar Disorders, 01/2013: pages 587-678; , ISBN: 978-94-007-1332-1
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