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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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2
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Scelsa B. Fetal Neurology: From Prenatal Counseling to Postnatal Follow-Up. Diagnostics (Basel) 2022; 12:diagnostics12123083. [PMID: 36553090 PMCID: PMC9776544 DOI: 10.3390/diagnostics12123083] [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: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Brain abnormalities detected in fetal life are being increasingly recognized. Child neurologists are often involved in fetal consultations, and specific fetal neurology training has been implemented in many countries. Pediatric neurologists are asked to examine the data available and to contribute to the definition of the long-term outcomes. Ventriculomegaly, posterior fossa malformations, and agenesis/dysgenesis of corpus callosum are among the most common reasons for antenatal neurological consultations. Fetuses with central nervous system and extra-CNS anomalies should ideally be managed in secondary/tertiary hospitals where obstetricians who are experts in fetal medicine and pediatric specialists are available. Obstetricians play a critical role in screening, performing detailed neurosonography, and referring to other specialists for additional investigations. Clinical geneticists are frequently asked to propose diagnostic tests and counsel complex fetal malformations whose phenotypes may differ from those during postnatal life. Advances in fetal MRI and genetic investigations can support the specialists involved in counseling. Nevertheless, data interpretation can be challenging, and it requires a high level of expertise in a multidisciplinary setting. Postnatally, child neurologists should be part of an integrated multidisciplinary follow-up, together with neonatologists and pediatricians. The neurodevelopmental outcomes should be assessed at least up to school age. Children should be evaluated with formal tests of their gross motor, cognitive, language, fine motor/visuo-perceptual skills, and their behavior. In this perspective, fetal neurology can be regarded as the beginning of a long journey which continues with a prolonged, structured follow-up, support to the families, and transition to adult life. A review of the most common conditions is presented, along with the long-term outcomes and a proposal of the neurodevelopmental follow-up of children with CNS malformation which are diagnosed in uterus.
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Affiliation(s)
- Barbara Scelsa
- Department of Pediatric Neurology and Psychiatry, V. Buzzi Children's Hospital, ASST-FBF-Sacco, via Castelvetro 32, 20154 Milan, Italy
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Yadav A, Singh C, Dagar S, Shastri A, Prakash R, Thakur S. A myriad of posterior fossa cysts: A single center experience. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1312-1319. [PMID: 35730722 DOI: 10.1002/jcu.23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Antenatal posterior fossa cystic lesions are intimidating due to overlapping imaging features of benign and severe malformations. Sonographic assessment of the posterior fossa with good resolution median sagittal and axial views, either primary or secondarily reconstructed, plays the lead role in antenatal evaluation, further enhanced when sequential assessments are added. We present 10 cases of fetal posterior fossa cystic lesions diagnosed in the first and second trimesters that were sequentially analyzed and followed up till delivery or termination. The ultrasound imaging appearance, evolution, and morphometry have been presented in this article.
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Affiliation(s)
- Arushi Yadav
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, and BirthRight by Rainbow Hospitals, New Delhi, India
| | - Chanchal Singh
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, and BirthRight by Rainbow Hospitals, New Delhi, India
| | - Savita Dagar
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, and BirthRight by Rainbow Hospitals, New Delhi, India
| | - Aditi Shastri
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, and BirthRight by Rainbow Hospitals, New Delhi, India
| | - Ritika Prakash
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, and BirthRight by Rainbow Hospitals, New Delhi, India
| | - Seema Thakur
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, and BirthRight by Rainbow Hospitals, New Delhi, India
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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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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
- * E-mail: (SA); (TT)
| | - 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
- * E-mail: (SA); (TT)
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Ulrich J, Caird J, Crimmins D. Predicting outcomes in Dandy-Walker malformation: a retrospective cohort study. J Neurosurg Pediatr 2021:1-6. [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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Ibrahim RSM, Hachem RH. Pediatric cerebellar malformations: magnetic resonance diagnostic merits and correlation with neurodevelopmental outcome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00152-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In spite of having many classifications for pediatric cerebellar malformations (PCMs), no broadly accepted classification is recommended. Associated neurodevelopmental outcomes in children with PCMs remain poorly defined. Neuroimaging is compulsory for the diagnosis of cerebellar malformation and their associated abnormalities. This article emphasizes on the clinical and radiological traits of PCMs. It proposes a radiological classification and a diagnostic approach and assesses whether specific neuroimaging features in patients with PCM correlate with their neurodevelopmental outcomes.
Results
Fifty-eight pediatric patients were classified as follows: The majority of about 51 cases (88%) showed cerebellar hypoplasia and the remaining 7 cases (12%) showed cerebellar dysplasia. Twenty-six patients (45%) remained undiagnosed, while 32 patients (55%) were having a final diagnosis (24% Dandy-Walker malformation (DWM) (n = 14), 7% isolated vermian hypoplasia (n = 4), 7% congenital disorder of glycosylation (CDG) (n = 4), 5% congenital muscular dystrophy (n = 3), 5% congenital cytomegalovirus (CMV) infection (n = 30), 3% rhombencephalosynapsis (n = 2), 2% Lhermitte-Duclos syndrome (n = 1), and 2% DWM with Joubert syndrome (n = 1)). Overall, for the neurodevelopmental outcome, the majority of patients 90% (52/58) had a global developmental delay (GDD) which is a delay in two or more developmental domains. Both motor and language delay represented about 72% (37/58), intellectual disability was present in 59% (34/58), epilepsy in 53% (31/58), ataxic gait in 57% (33/58), attention deficit hyperactivity disorder (ADHD) in 19% (11/58), autism spectrum disorder (ASD) in 17% (10/58), nystagmus and tremors in 15% (9/58), and behavioral changes in 7% (6/58). Most of the children with cerebellar hypoplasia, about 93%, had GDD. Also, patients with PCH associated with a severe GDD, 75% had a language delay, 50% had intellectual and motor delay, and about 25% had epilepsy. However, we observed mild GDD in half of the vermian hypoplasia cases and half of them had a mild fine motor delay.
Conclusions
Magnetic resonance imaging (MRI) of the pediatric brain provides key information to categorize and classify cerebellar malformations. A neurodevelopmental deficit is highly associated with different types of PCMs. Severe GDD was associated with cerebellar and brain stem involvement. However, children with vermis mal-development were likely to have mild GDD. Familiarity with their diagnostic criteria is mandatory for correct diagnosis and prognosis for patients.
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Cater SW, Boyd BK, Ghate SV. Abnormalities of the Fetal Central Nervous System: Prenatal US Diagnosis with Postnatal Correlation. Radiographics 2020; 40:1458-1472. [PMID: 32706613 DOI: 10.1148/rg.2020200034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fetal central nervous system (CNS) abnormalities are second only to cardiac malformations in their frequency of occurrence. Early and accurate diagnosis at prenatal US is therefore essential, allowing improved prenatal counseling and facilitating appropriate referral. Thorough knowledge of normal intracranial anatomy and adoption of a logical sonographic approach can improve depiction of abnormal findings, leading to a more accurate differential diagnosis earlier in pregnancy. Four standard recommended views-transventricular, falx, cavum, and posterior fossa or transcerebellar views-provide an overview of fetal intracranial anatomy during the second trimester anatomy scan. Essential elements surveyed in the head and neck include the lateral cerebral ventricles, choroid plexus, midline falx, cavum septi pellucidi, cerebellum, cisterna magna, upper lip, and nuchal fold. CNS abnormalities can be organized into six main categories at prenatal US. Developmental anomalies include neural tube defects and neuronal migration disorders. Posterior fossa disorders include Dandy-Walker malformation variants and Chiari II malformation. Ventricular anomalies include aqueductal stenosis. Midline disorders include those on the spectrum of holoprosencephaly, agenesis of the corpus callosum, and septo-optic dysplasia. Vascular anomalies include vein of Galen malformations. Miscellaneous disorders include hydranencephaly, porencephaly, tumors, and intracranial hemorrhage. Correlation with postnatal MRI is helpful for confirmation and clarification of suspected diagnoses after birth. The authors discuss a standard US imaging approach to the fetal CNS and review cases in all categories of CNS malformations, providing postnatal MRI correlation when available.©RSNA, 2020.
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Affiliation(s)
- Sarah W Cater
- From the Department of Radiology (S.W.C., S.V.G.) and Department of Obstetrics & Gynecology (B.K.B.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Brita K Boyd
- From the Department of Radiology (S.W.C., S.V.G.) and Department of Obstetrics & Gynecology (B.K.B.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Sujata V Ghate
- From the Department of Radiology (S.W.C., S.V.G.) and Department of Obstetrics & Gynecology (B.K.B.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710
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Blake's Pouch Cysts and Differential Diagnoses in Prenatal and Postnatal MRI : A Pictorial Review. Clin Neuroradiol 2020; 30:435-445. [PMID: 31942658 DOI: 10.1007/s00062-019-00871-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/16/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The clinical variability of Blake's pouch cysts (BPC) may range from asymptomatic via ataxia to sequelae of decompensated hydrocephalus. On the other hand, Dandy-Walker malformation (DWM) and cerebellar vermis hypoplasia generally correlate with less favorable neurologic development. The aim was to illustrate the potential of prenatal and postnatal neuroimaging to distinguish a BPC or persistent BP from other posterior fossa malformations. METHODS This pictorial review addresses the inconsistent nomenclature, clinical features, and magnetic resonance imaging (MRI) patterns of BPC and five differential diagnoses. The MRI findings of 11 patients, acquired at up to 3 T in 3 institutions, are demonstrated. Furthermore, the literature was searched for recent improvements in genetic and embryological background knowledge. RESULTS Posterior fossa malformations often resemble each other and may even be imitated by sequelae of hemorrhagic, ischemic or infectious disruptions, i.e. congenital anomalies of morphology despite normal developmental potential. Hydrocephalus is a typical, albeit not always congenital finding in BPC. It is frequently associated with cerebellar disruptions and DWM; however, it is also a rare complication of posterior fossa arachnoid cysts. A moderately elevated vermis needs follow-up to confirm persistent BP versus vermian hypoplasia or DWM. The fetal cerebellar tail, previously assumed to be specific for DWM, may be imitated in cases of persistent BP. CONCLUSION The accurate diagnosis of isolated BPC is not always straightforward, which is especially critical in the context of fetomaternal medicine. A detailed description of posterior fossa malformations is to be preferred over unspecific terminology.
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Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis: insights from a multicentre study. Eur Radiol 2020; 30:2161-2170. [PMID: 31900695 DOI: 10.1007/s00330-019-06538-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/04/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV). METHODS This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated). RESULTS Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7%). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21% (95% CI, 60.4-96.6%), specificity of 80.8% (95% CI, 60.6-93.4%), positive predictive value of 76% (95% CI, 58.7-87.8%), and negative predictive value of 87.5% (95% CI, 70.9-95.2%). CONCLUSIONS MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases. KEY POINTS • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the "cerebellar tail sign" has a sensitivity of 84.21% (95% CI, 60.4-96.6%) and specificity of 80.8% (95% CI, 60.6-93.4%) in predicting the persistence of the vermian rotation at imaging follow-up.
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Pinchefsky EF, Accogli A, Shevell MI, Saint-Martin C, Srour M. Developmental outcomes in children with congenital cerebellar malformations. Dev Med Child Neurol 2019; 61:350-358. [PMID: 30320441 DOI: 10.1111/dmcn.14059] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 12/29/2022]
Abstract
AIM Neurodevelopmental outcomes in children with congenital cerebellar malformations (CCMs) remain poorly defined. We aimed to assess whether specific neuroimaging features in CCM patients correlate with neurodevelopmental outcomes. METHOD Hospital records and neuroimaging of 67 children with CCMs were systematically reviewed. Logistic regression analyses were used to assess associations between specific imaging features and neurodevelopmental outcomes. RESULTS CCM categories were distributed as follows: 28 percent isolated vermis hypoplasia (n=19), 28 percent global cerebellar hypoplasia (n=19), 15 percent Dandy-Walker malformation (n=10), 13 percent pontocerebellar hypoplasia (PCH, n=9), 9 percent molar tooth malformation (n=6), 3 percent rhombencephalosynapsis (n=2), and 3 percent unilateral cerebellar malformation (n=2). Overall, 85 percent (55/65) of the cohort had global developmental delay (GDD). Intellectual disability was present in 61 percent (27/43) and autism spectrum disorder (ASD) in 12 percent (6/52). Adjusting for supratentorial malformations and presence of genetic findings, severe GDD was associated with cerebellar hypoplasia (p=0.049) and PCH (p=0.030), whereas children with vermis hypoplasia were less likely to have severe GDD (p=0.003). Presence of supratentorial abnormalities was not significantly associated with worse neurodevelopmental outcome but was associated with epilepsy. INTERPRETATION Children with CCMs have high prevalence of neurodevelopmental deficits. Specific features on imaging can aid prognostication and establish early intervention strategies. WHAT THIS PAPER ADDS Atypical long-term neurodevelopmental outcome is very common in patients with congenital cerebellar malformations (CCMs). Involvement of the brainstem and cerebellar hemispheres predicts more severe neurodevelopmental disability. Most patients with vermis hypoplasia have language delay but are verbal. Supratentorial abnormalities are not significantly associated with worse neurodevelopmental outcome but are associated with epilepsy. Comorbidities are common in CCMs, especially ophthalmological issues in cerebellar hypoplasia and sensorineural hearing loss in pontocerebellar hypoplasia.
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Affiliation(s)
- Elana F Pinchefsky
- Division of Pediatric Neurology, Department of Pediatrics, Neurology/Neurosurgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Andrea Accogli
- Division of Pediatric Neurology, Department of Pediatrics, Neurology/Neurosurgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,IRCCS Istituto Giannina Gaslini, Genova, Italy.,DINOGMI - Università di Genova, Genova, Italy
| | - Michael I Shevell
- Division of Pediatric Neurology, Department of Pediatrics, Neurology/Neurosurgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Christine Saint-Martin
- Department of Radiology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Myriam Srour
- Division of Pediatric Neurology, Department of Pediatrics, Neurology/Neurosurgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
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Belser-Ehrlich J, Adrian Lafo J, 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 2019; 34:591-610. [PMID: 30821610 DOI: 10.1080/13854046.2019.1569724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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)
- Janna Belser-Ehrlich
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jacob Adrian Lafo
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Paul Mangal
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Margaret Bradley
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Meredith Wicklund
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
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Abstract
Disorders of the developing nervous system may be of genetic origin, comprising congenital malformations of spine and brain as well as metabolic or vascular disorders that affect normal brain development. Acquired causes include congenital infections, hypoxic-ischemic or traumatic brain injury, and a number of rare neoplasms. This chapter focuses on the clinical presentation and workup of neurogenetic disorders presenting in the fetal or neonatal period. After a summary of the most frequent clinical presentations, clues from history taking and clinical examination are illustrated with short case reports. This is followed by a discussion of the different tools available for the workup of neurogenetic disorders, including the various genetic techniques with their advantages and disadvantages. The implications of a molecular genetic diagnosis for the patient and family are addressed in the section on counseling. The chapter concludes with a proposed workflow that may help the clinician when confronted with a potential neurogenetic disorder in the fetal or neonatal period.
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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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Dandy-Walker Syndrome: A Review of New Diagnosis and Management in Children. JOURNAL OF PEDIATRICS REVIEW 2018. [DOI: 10.5812/jpr.63486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yang R, Li R, Liu X, Fan L, Zhang J, Wang L, Teng H. Measurement of Fetal Mesencephalon and Pons Via Ultrasonographic Cross Sectional Imagining. Fetal Pediatr Pathol 2018; 37:38-48. [PMID: 29336643 DOI: 10.1080/15513815.2017.1397069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study evaluated the feasibility of measuring the fetal mesencephalon and pons by ultrasonographic cross sectional imaging to detect fetal central nervous system developmental abnormalities. MATERIALS AND METHODS Fetal ultrasonographic measurements included: Fetal mesencephalon anteroposterior diameters (MAD), mesencephalon transverse diameters (MTD), pons anteroposterior diameter (PAD) and proximal transverse diameters (PTD). RESULTS Nine-hundred ninety fetuses were imaged. Thirty-eight fetuses (observation group) presented central nervous system abnormalities; 952 fetuses without imaged abnormalities were utilized as the reference (control) group. Fetal MAD, MTD, PAD, and PTD in control fetuses showed a linear correlation with gestational age. Thirty-eight fetuses had 40 abnormal measurements (8 MAD, 8 MTD, 14 PAD, and 10 PTD), 16 in mesencephalon, and 24 in pons. All data fell below the 95% confidence intervals' lower limits for the corresponding gestational age. CONCLUSION Using normative data based on 957 fetuses allows detection of size abnormalities of the pons and midbrain during fetal life.
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Affiliation(s)
- Ruiqi Yang
- a Department of Obstetrics and gynecology , The Second Hospital of Jinlin Univsity , Changchun , China
| | - Rui Li
- b Emergency Department , The Affiliated Hospital to Changchun University of Chinese Medicine , Changchun , China
| | - Xuejuan Liu
- c Department of Pathology , The First Hospital of Jilin University , Changchun , China
| | - Limei Fan
- a Department of Obstetrics and gynecology , The Second Hospital of Jinlin Univsity , Changchun , China
| | - Jialing Zhang
- a Department of Obstetrics and gynecology , The Second Hospital of Jinlin Univsity , Changchun , China
| | - Libo Wang
- d Department of Electrical diagnosis , Jilin Maternal and Child Health Hospital , Changchun , China
| | - Hong Teng
- a Department of Obstetrics and gynecology , The Second Hospital of Jinlin Univsity , Changchun , China
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Stambolliu E, Ioakeim-Ioannidou M, Kontokostas K, Dakoutrou M, Kousoulis AA. The Most Common Comorbidities in Dandy-Walker Syndrome Patients: A Systematic Review of Case Reports. J Child Neurol 2017. [PMID: 28635420 DOI: 10.1177/0883073817712589] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Dandy-Walker syndrome (DWS) is a rare neurologic multi-entity malformation. This review aimed at reporting its main nonneurologic comorbidities. METHODS Following PRISMA guidelines, search in Medline was conducted (2000-2014, keyword: dandy-walker). Age, sex, country, DWS type, consanguinity or siblings with DWS, and recorded coexistent conditions (by ICD10 category) were extracted for 187 patients (46.5% male, 43% from Asia) from 168 case reports. RESULTS Diagnosis was most often set in <1 year old (40.6%) or >12 years old (27.8%). One-third of cases had a chromosomal abnormality or syndrome (n = 8 PHACE), 27% had a cardiovascular condition (n = 7 Patent Ductus Arteriosus), 24% had a disease of eye and ear (n = 9 cataract); most common malignancy was nephroblastoma (n = 8, all Asian). Almost one-fifth had a mental illness diagnosis; only 6.4% had mild or severe intellectual disability. CONCLUSION The spread of comorbidities calls for early diagnosis and multidisciplinary research and practice, especially as many cases remain clinically asymptomatic for years.
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Affiliation(s)
- Emelina Stambolliu
- 1 Society of Junior Doctors, Athens, Greece.,2 Department of Internal Medicine, General Hospital of Kalavryta, Kalavryta, Greece
| | | | | | - Maria Dakoutrou
- 1 Society of Junior Doctors, Athens, Greece.,5 First Department of Paediatrics, "Aghia Sophia" Children's Hospital, University of Athens, Greece
| | - Antonis A Kousoulis
- 1 Society of Junior Doctors, Athens, Greece.,6 Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Abstract
The frequency and importance of the evaluation of the posterior fossa have increased significantly over the past 20 years owing to advances in neuroimaging. Conventional and advanced neuroimaging techniques allow detailed evaluation of the complex anatomic structures within the posterior fossa. A wide spectrum of cerebellar and brainstem malformations has been shown. Familiarity with the spectrum of cerebellar and brainstem malformations and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counseling. This article discusses cerebellar and brainstem malformations, with emphasis on neuroimaging findings (including diagnostic criteria), neurologic presentation, systemic involvement, prognosis, and recurrence.
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Mormina E, Briguglio M, Morabito R, Arrigo A, Marino S, Di Rosa G, Micalizzi A, Valente EM, Salpietro V, Vinci SL, Longo M, Granata F. A rare case of cerebellar agenesis: a probabilistic Constrained Spherical Deconvolution tractographic study. Brain Imaging Behav 2016; 10:158-67. [PMID: 25832852 DOI: 10.1007/s11682-015-9377-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aim of this study is to show the potential of probabilistic tractographic techniques, based on the Constrained Spherical Deconvolution (CSD) algorithms, in recognizing white matter fiber bundle anomalies in patients with complex cerebral malformations, such as cerebellar agenesis. The morphological and tractographic study of a 17-year-old male patient affected by cerebellar agenesis was performed by using a 3Tesla MRI scanner. Genetic and neuropsychological tests were carried out. An MRI morphological study showed the absence of both cerebellar hemispheres and the flattening of the anterior side of the pons. Moreover, it showed a severe vermian hypoplasia with a minimal vermian residual. The study recognized two thin cerebellar remnants, medially in contact with the small vermian residual, at the pontine level. The third ventricle, morphologically normal, communicated with a permagna cerebello-medullary cistern. Probabilistic CSD tractography identified some abnormal and aberrant infratentorial tracts, symmetrical on both sides. In particular, the transverse pontine fibers were absent and the following tracts with aberrant trajectories have been identified: "cerebello-thalamic" tracts; "fronto-cerebellar" tracts; and ipsilateral and contralateral "spino-cerebellar" tracts. Abnormal tracts connecting the two thin cerebellar remnants have also been detected. There were no visible alterations in the main supratentorial tracts in either side. Neuropsychiatric evaluation showed moderate cognitive-motor impairment with discrete adaptive compensation. Probabilistic CSD tractography is a promising technique that overcome reconstruction biases of other diffusion tensor-based approaches and allowed us to recognize, in a patient with cerebellar agenesis, abnormal tracts and aberrant trajectories of normally existing tracts.
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Affiliation(s)
- Enricomaria Mormina
- Neuroradiology Unit - Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, via Consolare Valeria, 1 A.O.U. Policlinico "G. Martino", 98125, Messina, Italy
| | - Marilena Briguglio
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - Rosa Morabito
- Neuroradiology Unit - Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, via Consolare Valeria, 1 A.O.U. Policlinico "G. Martino", 98125, Messina, Italy
| | - Alessandro Arrigo
- Neuroradiology Unit - Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, via Consolare Valeria, 1 A.O.U. Policlinico "G. Martino", 98125, Messina, Italy.
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Gabriella Di Rosa
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - Alessia Micalizzi
- IRCCS Casa Sollievo della Sofferenza, CSS-Mendel Laboratory, San Giovanni Rotondo, Italy
- Department of Biological and Environmental Science, University of Messina, Messina, Italy
| | - Enza Maria Valente
- IRCCS Casa Sollievo della Sofferenza, CSS-Mendel Laboratory, San Giovanni Rotondo, Italy
- Section of Neurosciences, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Vincenzo Salpietro
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit - Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, via Consolare Valeria, 1 A.O.U. Policlinico "G. Martino", 98125, Messina, Italy
| | - Marcello Longo
- Neuroradiology Unit - Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, via Consolare Valeria, 1 A.O.U. Policlinico "G. Martino", 98125, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit - Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, via Consolare Valeria, 1 A.O.U. Policlinico "G. Martino", 98125, Messina, Italy
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Abstract
Ultrasound and magnetic resonance imaging are the two imaging modalities used in the assessment of the fetus. Ultrasound is the primary imaging modality, whereas magnetic resonance is used in cases of diagnostic uncertainty. Both techniques have advantages and disadvantages and therefore they are complementary. Standard axial ultrasound views of the posterior fossa are used for routine scanning for fetal anomalies, with additional orthogonal views directly and indirectly obtainable using three-dimensional ultrasound techniques. Magnetic resonance imaging allows not only direct orthogonal imaging planes, but also tissue characterization, for example to search for blood breakdown products. We review the nomenclature of several posterior fossa anomalies using standardized criteria, and we review cerebellar abnormalities based on an etiologic classification.
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Gezer C, Ekin A, Sinem Gezer N, Solmaz U, Ozeren M. Quantitative Evaluation of the Fetal Cerebellar Vermis Using the Median View on Two-Dimensional Ultrasound. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e34870. [PMID: 27703661 PMCID: PMC5037970 DOI: 10.5812/iranjradiol.34870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022]
Abstract
Background Evaluation of the cerebellum and vermis is one of the integral parts of the fetal cranial anomaly screening. Objectives The aim of this study was to create a nomogram for fetal vermis measurements between 17 and 30 gestational weeks. Patients and Methods This prospective study was conducted on 171 volunteer pregnant women between March 2013 and December 2014. Measurements of the fetal cerebellar vermis diameters in the sagittal plane were performed by two-dimensional transabdominal ultrasonography. Results Optimal median planes were obtained in 117 of the cases. Vermian diameters as a function of gestational age were expressed by regression equations and the correlation coefficients were found to be highly statistically significant (P < 0.001). The normal mean (± standard deviation) for each gestational week was also defined. Conclusion This study presents the normal range of the two-dimensional fetal vermian measurements between 17 and 30 gestational weeks. In the absence of a three-dimensional ultrasonography, two-dimensional ultrasonography could also be used confidently with more time and effort.
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Affiliation(s)
- Cenk Gezer
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
- Corresponding author: Cenk Gezer, Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey. Tel: +90-5325239130, E-mail:
| | - Atalay Ekin
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Naciye Sinem Gezer
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ulas Solmaz
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Ozeren
- Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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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] [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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Klein JL, Lemmon ME, Northington FJ, Boltshauser E, Huisman TAGM, Poretti A. Clinical and neuroimaging features as diagnostic guides in neonatal neurology diseases with cerebellar involvement. CEREBELLUM & ATAXIAS 2016; 3:1. [PMID: 26770813 PMCID: PMC4712469 DOI: 10.1186/s40673-016-0039-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/10/2015] [Indexed: 02/07/2023]
Abstract
Cerebellar abnormalities are encountered in a high number of neurological diseases that present in the neonatal period. These disorders can be categorized broadly as inherited (e.g. malformations, inborn errors of metabolism) or acquired (e.g. hemorrhages, infections, stroke). In some disorders such as Dandy-Walker malformation or Joubert syndrome, the main abnormalities are located within the cerebellum and brainstem. In other disorders such as Krabbe disease or sulfite oxidase deficiency, the main abnormalities are found within the supratentorial brain, but the cerebellar involvement may be helpful for diagnostic purposes. In In this article, we review neurological disorders with onset in the neonatal period and cerebellar involvement with a focus on how characterization of cerebellar involvement can facilitate accurate diagnosis and improved accuracy of neuro-functional prognosis.
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Affiliation(s)
- Jessica L Klein
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Neurosciences Intensive Care Nursery Program, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Department of Pediatrics, Medical University of South Carolina, Charleston, SC USA
| | - Monica E Lemmon
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Neurosciences Intensive Care Nursery Program, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Division of Pediatric Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC USA
| | - Frances J Northington
- Neurosciences Intensive Care Nursery Program, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Eugen Boltshauser
- Division of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland
| | - Thierry A G M Huisman
- Neurosciences Intensive Care Nursery Program, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD USA
| | - Andrea Poretti
- Neurosciences Intensive Care Nursery Program, The Johns Hopkins University School of Medicine, Baltimore, MD USA ; Division of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland ; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD USA
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Bosemani T, Orman G, Boltshauser E, Tekes A, Huisman TAGM, Poretti A. Congenital Abnormalities of the Posterior Fossa. Radiographics 2015; 35:200-20. [DOI: 10.1148/rg.351140038] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Update on neuroimaging phenotypes of mid-hindbrain malformations. Neuroradiology 2014; 57:113-38. [DOI: 10.1007/s00234-014-1431-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/04/2014] [Indexed: 12/11/2022]
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Chapman T, Mahalingam S, Ishak GE, Nixon JN, Siebert J, Dighe MK. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: part 2, Posterior fossa disorders. Clin Imaging 2014; 39:167-75. [PMID: 25457569 DOI: 10.1016/j.clinimag.2014.10.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 01/15/2023]
Abstract
This second portion of a two-part review illustrates examples of posterior fossa disorders detectable on prenatal ultrasound and MRI, with postnatal or pathology correlation where available. These disorders are discussed in the context of an anatomic classification scheme described in Part 1 of this posterior fossa anomaly review. Assessment of the size and formation of the cerebellar hemispheres and vermis is critical. Diagnoses discussed here include arachnoid cyst, Blake's pouch cyst, Dandy-Walker malformation, vermian agenesis, Joubert syndrome, rhombencephalosynapsis, Chiari II malformation, ischemia, and tumors.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117.
| | - Sowmya Mahalingam
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Jason N Nixon
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Joseph Siebert
- Department of Pathology, Seattle Children's Hospital, PC.8.720, 4800 Sand Point Way NE, Seattle, WA, 98105
| | - Manjiri K Dighe
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
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Plunk MR, Chapman T. The fundamentals of fetal MR imaging: Part 1. Curr Probl Diagn Radiol 2014; 43:331-46. [PMID: 25060713 DOI: 10.1067/j.cpradiol.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
Congenital malformations detected in any fetal system using ultrasound may be further evaluated with magnetic resonance imaging (MRI) to improve counseling, to plan deliveries appropriately, and sometimes to enable fetal interventions. In this first half of a 2-part review, the history and safety factors regarding fetal MRI, as well as the practical aspects of image acquisition, are discussed. In addition, as central nervous system anomalies are most commonly and best evaluated using fetal MRI, challenging central nervous system anomalies, such as fetal ventriculomegaly, posterior anomalies, and neural tube defects, detected using prenatal ultrasound are also reviewed with a focus on the fundamental implications of these diagnoses.
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Affiliation(s)
- Matthew R Plunk
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Teresa Chapman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Department of Radiology, Seattle Children׳s Hospital, Seattle, WA.
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Poretti A, Boltshauser E, Doherty D. Cerebellar hypoplasia: Differential diagnosis and diagnostic approach. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2014; 166C:211-26. [DOI: 10.1002/ajmg.c.31398] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Garel C, Moutard ML. Main congenital cerebral anomalies: how prenatal imaging aids counseling. Fetal Diagn Ther 2014; 35:229-39. [PMID: 24577226 DOI: 10.1159/000358519] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/30/2013] [Indexed: 11/19/2022]
Abstract
The purpose of this article is to discuss some common cerebral lesions that may be detected during prenatal screening: corpus callosum dysgenesis, absent septum pellucidum, localized parenchymal ischemic-hemorrhagic lesions, megacisterna magna, Blake's pouch cyst, posterior fossa arachnoid cyst and Dandy-Walker malformation. For each cerebral defect, the main imaging findings are reminded, certain differential diagnoses are discussed and prenatal diagnostic accuracy is analyzed with emphasis on uncertainties encountered during analysis of ultrasound or magnetic resonance images. Detecting cerebral lesions in fetuses requires rapid counseling by neuropediatricians. Keeping in mind that the prenatal diagnostic accuracy is not 100%, the neuropediatricians have to answer the parents' questions regarding the outcome of the unborn child as well as the risk of recurrence for future pregnancies. This article is based on the authors' large experience in both prenatal imaging and neurocounseling. The frequently asked questions are set up. Answers are provided, underscoring the importance of an appropriate description of the cerebral defect, and therefore the pivotal role of prenatal imaging. However, prenatal neurocounseling remains challenging and the parents must be aware of uncertainties regarding both diagnostic accuracy and prognostic evaluation.
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Affiliation(s)
- Catherine Garel
- Department of Radiology, Hôpital d'Enfants Armand-Trousseau, Paris, France
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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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Basson MA, Wingate RJ. Congenital hypoplasia of the cerebellum: developmental causes and behavioral consequences. Front Neuroanat 2013; 7:29. [PMID: 24027500 PMCID: PMC3759752 DOI: 10.3389/fnana.2013.00029] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/09/2013] [Indexed: 12/14/2022] Open
Abstract
Over the last 60 years, the spotlight of research has periodically returned to the cerebellum as new techniques and insights have emerged. Because of its simple homogeneous structure, limited diversity of cell types and characteristic behavioral pathologies, the cerebellum is a natural home for studies of cell specification, patterning, and neuronal migration. However, recent evidence has extended the traditional range of perceived cerebellar function to include modulation of cognitive processes and implicated cerebellar hypoplasia and Purkinje neuron hypo-cellularity with autistic spectrum disorder. In the light of this emerging frontier, we review the key stages and genetic mechanisms behind cerebellum development. In particular, we discuss the role of the midbrain hindbrain isthmic organizer in the development of the cerebellar vermis and the specification and differentiation of Purkinje cells and granule neurons. These developmental processes are then considered in relation to recent insights into selected human developmental cerebellar defects: Joubert syndrome, Dandy–Walker malformation, and pontocerebellar hypoplasia. Finally, we review current research that opens up the possibility of using the mouse as a genetic model to study the role of the cerebellum in cognitive function.
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Affiliation(s)
- M Albert Basson
- Department of Craniofacial Development and Stem Cell Biology, King's College London London, UK ; Medical Research Council Centre for Developmental Neurobiology, King's College London London, UK
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Searson R, Hare DJ, Sridharan S. Neuropsychological and behavioural phenotype of Dandy-Walker variant presenting in chromosome 22 trisomy: a case study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2013; 17:102-106. [PMID: 23479418 DOI: 10.1177/1744629513482830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this study, a case of Dandy-Walker variant syndrome associated with trisomy 22 in a 17-year-old man is described. This is the first account of this combination in a person surviving into adulthood, and the neuropsychological and behavioural presentation is described in detail and a clinical formulation is presented for the benefit of researchers and clinicians.
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Affiliation(s)
- Ruth Searson
- Greater Manchester West Mental Health NHS Trust, UK
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35
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Midbrain and hindbrain malformations: advances in clinical diagnosis, imaging, and genetics. Lancet Neurol 2013; 12:381-93. [PMID: 23518331 DOI: 10.1016/s1474-4422(13)70024-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Historically, the midbrain and hindbrain have been considered of secondary importance to the cerebrum, which has typically been acknowledged as the most important part of the brain. In the past, radiologists and pathologists did not regularly examine these structures-also known as the brainstem and cerebellum-because they are small and difficult to remove without damage. With recent developments in neuroimaging, neuropathology, and neurogenetics, many developmental disorders of the midbrain and hindbrain have emerged as causes of neurodevelopmental dysfunction. These research advances may change the way in which we treat these patients in the future and will enhance the clinical acumen of the practising neurologist and thereby improve the diagnosis and treatment of these patients.
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Poretti A, Meoded A, Rossi A, Raybaud C, Huisman TAGM. Diffusion tensor imaging and fiber tractography in brain malformations. Pediatr Radiol 2013; 43:28-54. [PMID: 23288476 DOI: 10.1007/s00247-012-2428-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 04/09/2012] [Indexed: 01/19/2023]
Abstract
Diffusion tensor imaging (DTI) is an advanced MR technique that provides qualitative and quantitative information about the micro-architecture of white matter. DTI and its post-processing tool fiber tractography (FT) have been increasingly used in the last decade to investigate the microstructural neuroarchitecture of brain malformations. This article aims to review the use of DTI and FT in the evaluation of a variety of common, well-described brain malformations, in particular by pointing out the additional information that DTI and FT renders compared with conventional MR sequences. In addition, the relevant existing literature is summarized.
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Affiliation(s)
- Andrea Poretti
- Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Nelson Basement, B-173, Baltimore, MD 21287-0842, USA
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37
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Vasudevan C, McKechnie L, Levene M. Long-term outcome of antenatally diagnosed agenesis of corpus callosum and cerebellar malformations. Semin Fetal Neonatal Med 2012; 17:295-300. [PMID: 22840681 DOI: 10.1016/j.siny.2012.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recent advancements in fetal imaging and antenatal care have enabled identification of numerous anomalies including agenesis of corpus callosum and posterior fossa abnormalities. One of the important determinants of long-term prognosis in these conditions is the presence of central nervous system (CNS) and extra-CNS anomalies. The difficulty in confirming the isolated nature of these conditions antenatally and the lack of clear information regarding long-term prognoses makes it difficult for the clinician to provide accurate information to the parents antenatally. Caring for these families would require input from a multidisciplinary team involving obstetricians, geneticists, neurologists, radiologists and neonatologists.
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Affiliation(s)
- C Vasudevan
- University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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38
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de Oliveira AKP, Hamerschmidt R, Mocelin M, Rezende RK. Cochlear implantation in patient with Dandy-walker syndrome. Int Arch Otorhinolaryngol 2012; 16:406-9. [PMID: 25991966 PMCID: PMC4435434 DOI: 10.7162/s1809-97772012000300018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/01/2010] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Dandy Walker Syndrome is a congenital abnormality in the central nervous system, characterized by a deficiency in the development of middle cerebelar structures, cystic dilatation of the posterior pit communicating with the fourth ventricle and upward shift of the transverse sinuses, tentorium and dyes. Among the clinical signs are occipital protuberances, a progressive increase of the skull, bowing before the fontanels, papilledema, ataxia, gait disturbances, nystagmus, and intellectual impairment. OBJECTIVES To describe a case of female patient, 13 years old with a diagnosis of this syndrome and bilateral hearing loss underwent cochlear implant surgery under local anesthesia and sedation. CASE REPORT CGS, 13 years old female was referred to the Otolaryngological Department of Otolaryngology Institute of Parana with a diagnosis of "Dandy-Walker syndrome" for Otolaryngological evaluation for bilateral hearing loss with no response to the use of hearing aids. Final Comments: The field of cochlear implants is growing rapidly. We believe that the presence of Dandy-Walker syndrome cannot be considered a contraindication to the performance of cochlear implant surgery, and there were no surgical complications due to neurological disorders with very favorable results for the patient who exhibits excellent discrimination. It has less need for lip reading with improvement in speech quality.
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Affiliation(s)
| | - Rogerio Hamerschmidt
- Professor of Otolaryngology, Federal University of Parana. Otolaryngologist Doctor at, Hospital of Parana of Otolaryngology.
| | - Marcos Mocelin
- Head of the Department of Otolaryngology, Clinics Hospital, Federal University of Parana. Head of the Department of Otolaryngology, Clinics Hospital, Federal University of Parana.
| | - Rodrigo K. Rezende
- Resident of Otolaryngology at the Clinics Hospital, Federal University of Parana.
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39
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Gandolfi Colleoni G, Contro E, Carletti A, Ghi T, Campobasso G, Rembouskos G, Volpe G, Pilu G, Volpe P. Prenatal diagnosis and outcome of fetal posterior fossa fluid collections. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:625-631. [PMID: 22173885 DOI: 10.1002/uog.11071] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the accuracy of fetal imaging in differentiating between diagnoses involving posterior fossa fluid collections and to investigate the postnatal outcome of affected infants. METHODS This was a retrospective study of fetuses with posterior fossa fluid collections, carried out between 2001 and 2010 in two referral centers for prenatal diagnosis. All fetuses underwent multiplanar neurosonography. Parents were also offered fetal magnetic resonance imaging (MRI) and karyotyping. Prenatal diagnosis was compared with autopsy or postnatal MRI findings and detailed follow-up was attempted by consultation of medical records and interview with parents and pediatricians. RESULTS During the study period, 105 fetuses were examined, at a mean gestational age of 24 (range, 17-28) weeks. Sonographic diagnoses (Blake's pouch cyst, n = 32; megacisterna magna, n = 27; Dandy-Walker malformation, n = 26; vermian hypoplasia, n = 17; cerebellar hypoplasia, n = 2; arachnoid cyst, n = 1) were accurate in 88% of the 65 cases in which confirmation was possible. MRI proved more informative than ultrasound in only 1/51 cases. Anatomic anomalies and/or chromosomal aberrations were found in 43% of cases. Blake's pouch cysts and megacisterna magna underwent spontaneous resolution in utero in one third of cases and over 90% of survivors without associated anomalies had normal developmental outcome at 1-5 years. Isolated Dandy-Walker malformation and vermian hypoplasia were associated with normal developmental outcome in only 50% of cases. CONCLUSION Prenatal neurosonography and MRI are similarly accurate in the categorization of posterior fossa fluid collections from mid gestation. Blake's pouch cyst and megacisterna magna are risk factors for associated anomalies but when isolated have an excellent prognosis, with a high probability of intrauterine resolution and normal intellectual development in almost all cases. Conversely, Dandy-Walker malformation and vermian hypoplasia, even when they appear isolated antenatally, are associated with an abnormal outcome in half of cases.
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Affiliation(s)
- G Gandolfi Colleoni
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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40
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Ghi T, Contro E, De Musso F, Farina A, Conturso R, Bonasoni P, Salsi G, Youssef A, Rizzo N, Pilu G. Normal morphometry of fetal posterior fossa at midtrimester: brainstem-tentorium angle and brainstem-vermis angle. Prenat Diagn 2012; 32:440-3. [DOI: 10.1002/pd.3834] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tullio Ghi
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Elena Contro
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Francesca De Musso
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Antonio Farina
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | | | - Paola Bonasoni
- Pathology Unit; Arcispedale S.Maria Nuova; Reggio Emilia; Italy
| | - Ginevra Salsi
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Aly Youssef
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
| | - Gianluigi Pilu
- Department of Obstetrics and Gynaecology; St. Orsola Malpighi Hospital, University of Bologna; Bologna; Italy
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41
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Chokshi FH, Poretti A, Meoded A, Huisman TAGM. Normal and abnormal development of the cerebellum and brainstem as depicted by diffusion tensor imaging. Semin Ultrasound CT MR 2012; 32:539-54. [PMID: 22108217 DOI: 10.1053/j.sult.2011.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diffusion tensor imaging (DTI) is an advanced MRI technique that measures the microscopic molecular motion of water to gain information about the brain structure. This modality and its application to fiber tractography have been increasingly used in the last years to study the neuroanatomical background of brain malformations. This article aims to give an overview of the application of DTI and fiber tractography on pediatric posterior fossa including malformations, acquired disorders affecting the white matter, and posterior fossa involvement in phacomatoses. For every disorder, we show the additional information that DTI and fiber tractography are providing compared to conventional MR sequences and discuss their significance. Additionally, we show at the beginning normal DTI and fiber tractography findings of the pediatric posterior fossa. Finally, we briefly discuss potential future uses for DTI and fiber tractography to further understand the pathogenesis of posterior fossa malformations and the neuronal plasticity and connectivity of acquired lesions affecting the posterior fossa.
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Affiliation(s)
- Falgun H Chokshi
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Patek KJ, Kline-Fath BM, Hopkin RJ, Pilipenko VV, Crombleholme TM, Spaeth CG. Posterior fossa anomalies diagnosed with fetal MRI: Associated anomalies and neurodevelopmental outcomes. Prenat Diagn 2012; 32:75-82. [DOI: 10.1002/pd.2911] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kyla J. Patek
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Beth M. Kline-Fath
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Robert J. Hopkin
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Valentina V. Pilipenko
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Timothy M. Crombleholme
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Christine G. Spaeth
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- The Fetal Care Center of Cincinnati; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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43
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Barkovich AJ. Developmental disorders of the midbrain and hindbrain. Front Neuroanat 2012; 6:7. [PMID: 22408608 PMCID: PMC3294267 DOI: 10.3389/fnana.2012.00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/20/2012] [Indexed: 11/16/2022] Open
Abstract
Malformations of the midbrain (MB) and hindbrain (HB) have become topics of considerable interest in the neurology and neuroscience literature in recent years. The combined advances of imaging and molecular biology have improved analyses of structures in these areas of the central nervous system, while advances in genetics have made it clear that malformations of these structures are often associated with dysfunction or malformation of other organ systems. This review focuses upon the importance of communication between clinical researchers and basic scientists in the advancement of knowledge of this group of disorders. Disorders of anteroposterior (AP) patterning, cerebellar hypoplasias, disorders associated with defects of the pial limiting membrane (cobblestone cortex), disorders of the Reelin pathway, and disorders of the primary cilium/basal body organelle (molar tooth malformations) are the main focus of the review.
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Affiliation(s)
- A. James Barkovich
- Department of Radiology and Biomolecular Imaging, Neuroradiology Section, University of California at San Francisco, San FranciscoCA, USA
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44
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Prenatal MR imaging of Dandy-Walker complex: Midline sagittal area analysis. Eur J Radiol 2012; 81:e26-30. [DOI: 10.1016/j.ejrad.2010.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/18/2010] [Accepted: 11/03/2010] [Indexed: 11/18/2022]
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45
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Correa GG, Amaral LF, Vedolin LM. Neuroimaging of Dandy-Walker malformation: new concepts. Top Magn Reson Imaging 2011; 22:303-312. [PMID: 24132069 DOI: 10.1097/rmr.0b013e3182a2ca77] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dandy-Walker malformation (DWM) is the most common human cerebellar malformation, characterized by hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and an enlarged posterior fossa with upward displacement of the lateral sinuses, tentorium, and torcular. Although its pathogenesis is not completely understood, there are several genetic loci related to DWM as well as syndromic malformations and congenital infections. Dandy-Walker malformation is associated with other central nervous system abnormalities, including dysgenesis of corpus callosum, ectopic brain tissue, holoprosencephaly, and neural tube defects. Hydrocephalus plays an important role in the development of symptoms and neurological outcome in patients with DWM, and the aim of surgical treatment is usually the control of hydrocephalus and the posterior fossa cyst. Imaging modalities, especially magnetic resonance imaging, are crucial for the diagnosis of DWM and distinguishing this disorder from other cystic posterior fossa lesions. Persistent Blake's cyst is seen as a retrocerebellar fluid collection with cerebrospinal fluid signal intensity and a median line communication with the fourth ventricle, commonly associated with hydrocephalus. Mega cisterna magna presents as an extraaxial fluid collection posteroinferior to an intact cerebellum. Retrocerebellar arachnoid cysts frequently compress the cerebellar hemispheres and the fourth ventricle. Patients with DWM show an enlarged posterior fossa filled with a cystic structure that communicates freely with the fourth ventricle and hypoplastic vermis. Comprehension of hindbrain embryology is of utmost importance for understanding the cerebellar malformations, including DWM, and other related entities.
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Affiliation(s)
- Gustavo Gumz Correa
- From the *Hospital Moinhos de Vento, Porto Alegre; and †Medimagem, Hospital Beneficiência Portuguesa, São Paulo, Brazil
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Spennato P, Mirone G, Nastro A, Buonocore MC, Ruggiero C, Trischitta V, Aliberti F, Cinalli G. Hydrocephalus in Dandy-Walker malformation. Childs Nerv Syst 2011; 27:1665-81. [PMID: 21928031 DOI: 10.1007/s00381-011-1544-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Even if the first description of Dandy-Walker dates back 1887, difficulty in the establishment of correct diagnosis, especially concerning differential diagnosis with other types of posterior fossa CSF collection, still persists. Further confusion is added by the inclusion, in some classification, of different malformations with different prognosis and therapeutic strategy under the same label of "Dandy-Walker". METHODS An extensive literature review concerning embryologic, etiologic, pathogenetic, clinical and neuroradiological aspects has been performed. Therapeutic options, prognosis and intellectual outcome are also reviewed. CONCLUSION The correct interpretation of the modern neuroradiologic techniques, including CSF flow MR imaging, may help in identifying a "real" Dandy-Walker malformation. Among therapeutical strategies, single shunting (ventriculo-peritoneal or cyst-peritoneal shunts) appears effective in the control of both ventricle and cyst size. Endoscopic third ventriculostomy may be considered an acceptable alternative, especially in older children, with the aim to reduce the shunt-related problems. Prognosis and intellectual outcome mostly depend on the presence of associated malformations, the degree of vermian malformation and the adequate control of hydrocephalus.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono Children's Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
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Regional Cerebellar Volumes Predict Functional Outcome in Children with Cerebellar Malformations. THE CEREBELLUM 2011; 11:531-42. [DOI: 10.1007/s12311-011-0312-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bolduc ME, Du Plessis AJ, Sullivan N, Khwaja OS, Zhang X, Barnes K, Robertson RL, Limperopoulos C. Spectrum of neurodevelopmental disabilities in children with cerebellar malformations. Dev Med Child Neurol 2011; 53:409-16. [PMID: 21418200 DOI: 10.1111/j.1469-8749.2011.03929.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Advances in perinatal care and neuroimaging techniques have increased the detection of cerebellar malformations (CBMs) in the fetus and young infant. As a result, this has necessitated a greater understanding of the neurodevelopmental consequences of CBMs on child development. The aim of this study was to delineate the impact of CBMs on long-term neurodevelopmental outcomes. METHOD We conducted a cross-sectional study and systematically identified children with CBMs born between December 2000 and December 2006. We then performed follow-up magnetic resonance imaging studies, neurologic examination, and standardized neurodevelopmental outcome testing (Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale, Child Behavior Checklist, Modified Checklist for Autism in Toddlers, and the Pediatric Quality of Life Inventory). RESULTS Our sample comprised 49 children (29 males, 20 females; mean age, 28.4 mo, SD 16.4) with a CBM. Infants with evidence of acquired fetal or neonatal brain injury, intracranial birth trauma, inherited metabolic disease, or major pre- or postnatal cerebral ischemia were excluded. Our findings highlight that children with CBMs experience a high prevalence of neurologic, developmental, and functional disabilities including motor, cognitive, language, and social-behavioral deficits, as well as poor quality of life. The associated supratentorial anomalies, chromosomal findings, and malformations affecting the cerebellar vermis were significant independent predictors of neurodevelopmental disabilities in young children with CBMs. The associated supratentorial anomalies and chromosomal findings were also predictive of global developmental delay (p=0.01), cognitive impairment (p=0.03), gross and fine motor delay (p=0.02 and p=0.01 respectively), and positive screening for autism spectrum disorder (p=0.01). Additionally, malformations affecting the cerebellar vermis were significant independent predictors of expressive language (p=0.04) and gross motor delays (p=0.02). INTERPRETATION Developmental surveillance and early intervention programs should be an integral part of the long-term follow-up of survivors of CBM.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Abstract
Dandy-Walker malformation is a congenital disorder that involves the cerebellum and fourth ventricle. Regarding treatment, there is still controversy over the optimum surgical management. In the current study, we present 19 consecutive cases of Dandy-Walker malformation diagnosed between January 1992 and January 2008 that were treated in our institute. All patients presented with hydrocephalus at the time of diagnosis and were treated surgically. Combined drainage of the ventricular system and posterior fossa cyst, using a 3-way connector was performed in 5 patients. Posterior fossa cyst drainage alone was performed in 10 patients and the remaining 4 patients were treated by ventricular drainage alone. All patients improved after treatment. Dandy-Walker malformation is a developmental abnormality of the central nervous system associated with various brain and extracranial abnormalities. Surgical treatment remains controversial, whereas prognosis varies greatly according to the severity of syndrome and associated comorbidities.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, Children's Hospital Agia Sofia, Athens, Greece.
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Bui C, Picone O, Mas AE, Levaillant JM, Ami O, Netchine I, Frydman R, Senat MV. Beckwith-Wiedemann syndrome in association with posterior hypoplasia of the cerebellar vermis. Prenat Diagn 2009; 29:906-7. [DOI: 10.1002/pd.2312] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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