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Phi JH, Kim SK. Clinical Features and Treatment of Pediatric Cerebral Cavernous Malformations. J Korean Neurosurg Soc 2024; 67:299-307. [PMID: 38547881 PMCID: PMC11079565 DOI: 10.3340/jkns.2024.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Cerebral cavernous malformation (CCM) is a vascular anomaly commonly found in children and young adults. Common clinical presentations of pediatric patients with CCMs include headache, focal neurological deficits, and seizures. Approximately 40% of pediatric patients are asymptomatic. Understanding the natural history of CCM is crucial and hemorrhagic rates are higher in patients with an initial hemorrhagic presentation, whereas it is low in asymptomatic patients. There is a phenomenon known as temporal clustering in which a higher frequency of symptomatic hemorrhages occurs within a few years following the initial hemorrhagic event. Surgical resection remains the mainstay of treatment for pediatric CCMs. Excision of a hemosiderin-laden rim is controversial regarding its impact on epilepsy outcomes. Stereotactic radiosurgery is an alternative treatment, especially for deepseated CCMs, but its true efficacy needs to be verified in a clinical trial.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
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Poretti A, Boltshauser E, Huisman TAGM. Prenatal Cerebellar Disruptions: Neuroimaging Spectrum of Findings in Correlation with Likely Mechanisms and Etiologies of Injury. Neuroimaging Clin N Am 2017; 26:359-72. [PMID: 27423799 DOI: 10.1016/j.nic.2016.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is increasing evidence that the cerebellum is susceptible to prenatal infections and hemorrhages and that congenital morphologic anomalies of the cerebellum may be caused by disruptive (acquired) causes. Starting from the neuroimaging pattern, this report describes a spectrum of prenatal cerebellar disruptions including cerebellar agenesis, unilateral cerebellar hypoplasia, cerebellar cleft, global cerebellar hypoplasia, and vanishing cerebellum in Chiari type II malformation. The neuroimaging findings, possible causative disruptive events, and clinical features of each disruption are discussed. Recognition of cerebellar disruptions and their differentiation from cerebellar malformations is important in terms of diagnosis, prognosis, and genetic counselling.
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Affiliation(s)
- Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Charlotte R. Bloomberg Children's Center, The Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD 21287-0842, USA; Department of Pediatric Neurology, University Children's Hospital, Steinwiesstrasse 75, Zurich 8032, Switzerland.
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Steinwiesstrasse 75, Zurich 8032, Switzerland
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Charlotte R. Bloomberg Children's Center, The Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD 21287-0842, USA
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Abstract
The vulnerability of the cerebellum during prenatal life to disruptive events such as hemorrhage and infection leads to a wide variety of morphological abnormalities. This review discusses various prenatal cerebellar disruptions including cerebellar agenesis, unilateral cerebellar hypoplasia, cerebellar cleft, global cerebellar hypoplasia, and vanishing cerebellum in Chiari type II malformation. For each entity, we discuss the definition, potential pathomechanism, clinical findings including neurocognitive and behavioral problems, neuroimaging features, and management. Accurate recognition of cerebellar disruptions and their differentiation from malformations is important in terms of diagnosis, prognosis, and genetic counselling.
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Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology and Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology and Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hayashi M, Poretti A, Gorra M, Farzin A, Graham EM, Huisman TAGM, Northington FJ. Prenatal cerebellar hemorrhage: fetal and postnatal neuroimaging findings and postnatal outcome. Pediatr Neurol 2015; 52:529-34. [PMID: 25724371 DOI: 10.1016/j.pediatrneurol.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite significant progress in fetal neuroimaging techniques, only a few well-documented examples of prenatal cerebellar hemorrhages are available in the literature. In the majority of these individuals, the diagnosis of prenatal cerebellar hemorrhages led to termination of pregnancy or death occurred in utero; data about postnatal outcome of children with prenatal diagnosis of cerebellar hemorrhages are scant. We describe fetal and postnatal neuroimaging findings and the neurodevelopmental outcome of a child with a large cerebellar hemorrhage that occurred at approximately 27 weeks' gestation. METHOD Data about neurological features and neurodevelopmental outcome were collected from the clinical history and follow-up examination. All pre- and postnatal MRI data were qualitatively evaluated for infra- and supratentorial abnormalities. RESULTS Fetal MRI at 27 weeks' gestation showed a T1-hyperintense and T2-hypointense lesion within the cerebellum suggestive of bilateral cerebellar hemorrhages with extension into the adjacent subarachnoid, subdural, and intraventricular spaces. The prenatal cerebellar hemorrhage was possibly related to maternal sepsis. Postnatal MRI showed encephalomalacic changes involving the vermis and both cerebellar hemispheres. Neurodevelopmental follow-up at 15 months of age was concerning for global developmental delay and significant right esotropia. CONCLUSION This child illustrates (1) the role of prenatal neuroimaging in the diagnosis of fetal cerebellar hemorrhages, (2) the significance of cerebellar involvement for neurodevelopment, and (3) the importance of the collection of postnatal outcome data in children with prenatal diagnosis of cerebellar hemorrhage.
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Affiliation(s)
- Madoka Hayashi
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea Poretti
- Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Azadeh Farzin
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | - Ernest M Graham
- Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thierry A G M Huisman
- Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frances J Northington
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Desvignes F, Beaufrère AM, Biard M, Déchelotte P, Laurichesse-Delmas H, Lemery D, Gallot D. [Prenatal diagnosis of cerebral tumors and differential diagnosis]. ACTA ACUST UNITED AC 2013; 42:290-6. [PMID: 23357711 DOI: 10.1016/j.jgyn.2012.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 12/12/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
Abstract
Fetal brain tumors are rare and have different histologies. Although the definitive diagnosis relies on the histopathology of the tumor, it is useful to distinguish the tumors potentially curable from the tumors rapidly fatal after birth. Nevertheless, some intracranial masses are not tumors. We report four cases of intracerebral masses diagnosed prenatally corresponding to different histological lesions: teratoma, fetus-in-fetu, chraniopharyngioma, hemangioma. We discuss the elements of the differential diagnosis, which can be identified prenatally.
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Affiliation(s)
- F Desvignes
- Pôle de gynéco-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
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Sarnat HB, Wei XC, Flores-Sarnat L, Trevenen CL, Barlow K. Fetal opercular cavernous angioma causing cerebral cleft: contralateral primitive vascular anomaly and subicular dysgenesis. J Child Neurol 2012; 27:478-84. [PMID: 21968978 DOI: 10.1177/0883073811420293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe a 22-week female fetus after pregnancy was terminated because of fetal magnetic resonance imaging showing a large left cerebral hemispheric cleft suggestive of porencephaly or schizencephaly. Postmortem examination revealed a large cavernous angioma of the left opercular region with evidence of previous hemorrhage and extensive cerebral infarction. In the right hemisphere, another vascular malformation within the frontal germinal matrix consisted of an aggregate of primitive vessels not yet canalized. Selective dysgenesis of the right subiculum also was demonstrated. This case illustrates not only a severe encephaloclastic effect of cavernous angioma in fetal brain but also the importance of fetal autopsy to help correlate and explain fetal neuroimaging. Potential future prenatal treatment of fetal angiomata requires precise in utero diagnosis.
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Affiliation(s)
- Harvey B Sarnat
- Department of Paediatrics (Neurology), University of Calgary Faculty of Medicine and Alberta Children's Hospital, Calgary, Alberta, Canada.
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Mori N, Yanagihara T, Nagasaka H, Katsuki N, Haba R, Nishiyama Y, Tamiya T, Itoh S, Hata T. Antenatal ultrasonographic features of fetal capillary hemangioma in the posterior fossa. J Obstet Gynaecol Res 2010; 37:79-83. [PMID: 21040213 DOI: 10.1111/j.1447-0756.2010.01322.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A capillary hemangioma with hydrocephalus in the posterior fossa of a fetus was detected on ultrasonography at 38 weeks and 4 days of gestation. A well-defined, round tumor with a mixed pattern occupied the posterior fossa, and the normal cerebellum was significantly compressed by this tumor. No other anomaly was detected. Delivery was induced because of rapidly progressive hydrocephalus, and an otherwise healthy female infant weighing 2800 g was delivered vaginally at 39 weeks and 4 days of gestation. Histologic examination of the lesion through biopsy demonstrated capillary hemangioma. The tumor spontaneously decreased in size, and disappeared six months later. The child is now 2 years of age, and is developing normally.
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Affiliation(s)
- Nobuhiro Mori
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, Ikenobe, Miki, Kagawa, Japan
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Limperopoulos C, Folkerth R, Barnewolt CE, Connolly S, Du Plessis AJ. Posthemorrhagic cerebellar disruption mimicking Dandy-Walker malformation: fetal imaging and neuropathology findings. Semin Pediatr Neurol 2010; 17:75-81. [PMID: 20434704 DOI: 10.1016/j.spen.2010.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Catherine Limperopoulos
- Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy, Montreal, Quebec, Canada.
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Poretti A, Prayer D, Boltshauser E. Morphological spectrum of prenatal cerebellar disruptions. Eur J Paediatr Neurol 2009; 13:397-407. [PMID: 18945628 DOI: 10.1016/j.ejpn.2008.09.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Revised: 06/25/2008] [Accepted: 09/01/2008] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that the cerebellum is susceptible to both prenatal infections and haemorrhages as well as being vulnerable in extremely preterm babies, but not to perinatal and postnatal hypoxic-ischaemic injuries. Starting with the imaging appearance we describe and illustrate a spectrum of prenatal cerebellar disruptions: cerebellar agenesis; unilateral cerebellar hypoplasia; unilateral cerebellar cleft; global cerebellar hypoplasia; vanishing cerebellum in myelomeningocele; and disruption of cerebellar development in preterm infants. We discuss neuroradiological characteristics, possible disruptive events, and clinical findings in the different morphological patterns. Remarkably, the same disruptive agent can cause different neuroradiological patterns, which appear likely to represent a morphological spectrum. The analysis of imaging patterns is crucial in recognising cerebellar disruptions. Recognition of cerebellar disruptions and their differentiation from cerebellar malformations is important in terms of diagnosis, prognosis, and genetic counselling.
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Affiliation(s)
- Andrea Poretti
- Department of Paediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland
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Malinger G, Lev D, Lerman-Sagie T. The fetal cerebellum. Pitfalls in diagnosis and management. Prenat Diagn 2009; 29:372-80. [DOI: 10.1002/pd.2196] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nomura ML, Barini R, de Andrade KC, Faro C, Marins M. Prenatal diagnosis of isolated fetal cerebellar hemorrhage associated with maternal septic shock. Prenat Diagn 2008; 29:169-71. [DOI: 10.1002/pd.2155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sherer DM, Sokolovski M, Dalloul M, Pezzullo JC, Osho JA, Abulafia O. Nomograms of the axial fetal cerebellar hemisphere circumference and area throughout gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:32-37. [PMID: 17171631 DOI: 10.1002/uog.3879] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The widely applied transcerebellar diameter (TCD) obtained at axial cranial imaging, measures the distance between the lateral aspects of the cerebellum and incorporates the width of the cerebellar vermis. Our objective was to create reference ranges of axial fetal cerebellar hemisphere circumference (CHC) and area (CHA), independent of the cerebellar vermis, throughout gestation. METHODS This cross-sectional study involved pregnant patients between 14 and 41 weeks of gestation. Inclusion criteria consisted of well-established dates (confirmed by early ultrasound), non-anomalous singleton fetuses and intact amniotic membranes. Sonographic measurements included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), humerus length (HL), TCD, and estimated fetal weight (EFW). Values of axial fetal CHC and CHA were each calculated as the mean of three separate measurements. The 5th, 50th and 95th centiles were estimated at each week of gestational age (GA) by least-squares regression for the mean and standard deviation (SD) of the CHC and CHA as functions of GA. r2 and associated P-values for the relationships of CHC and CHA with other sonographic biometric measurements were calculated. RESULTS The study included 651 consecutive patients. All attempts at obtaining axial fetal CHC and CHA were successful. Mean maternal age was 27.3+/-6.7 years, median gravidity was 1 (range 1-16), and median parity was 1 (range 0-6). Mean CHC (cm) throughout gestation was modeled as -2.091+0.2563xGA (weeks) (SD=-0.075+0.0164xGA), and mean CHA (cm2) was modeled as 0.245-0.0765xGA+0.00506xGA2 (SD=1.167-0.1565xGA+0.006785xGA(2)-0.00008028xGA3). Fetal axial CHC and CHA correlated significantly and strongly with BPD, HC, AC, HL, FL, TCD and EFW (all R2 values were >or=0.95, and all P-values were <0.001). CONCLUSION Nomograms of axial fetal cerebellar hemisphere circumference and area throughout gestation, independent of the cerebellar vermis, have been provided.
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Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - M Sokolovski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - M Dalloul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - J C Pezzullo
- Department of Pharmacology, Georgetown University, Washington, DC, USA
| | - J A Osho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - O Abulafia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
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