Prenatal diagnosis and management of a craniofacial glioma detected at 20 weeks' gestation. Case report and review of the literature

Frontonasal glioma - diagnostic difficulties

Nasal glioma or nasal glial heterotopia represents a rare rare benign tumor of the median line. Prenatal and even postnatal imagingc diagnosis of congenital frontonasal masses is difficult. We describe the case of an infant presenting with a lateral nasal mass. The characteristics of the prenatal magnetic resonance imaging and the postnatal clinical examination argued in favor of a congenital hemangioma. The non-regressive aspect of hemangioma under Propranolol therapy pleaded for a possible non-involuting congenital hemangioma. To rule out other diagnosis we performed a postnatal magnetic resonance imaging that indicated a tissue lesion and ruled out an encephalocele. Surgical treatment was performed. The histologic examination revealed glial tissue and connective tissue, with immunohistochemistry confirming nasal glial heterotopia. Nasal glioma can be misdiagnosed as hemangioma. Magnetic resonance imaging and pathology with immunohistochemistry are the mainstay of diagnosis.

Nasal glial heterotopia or congenital hemangioma? A case report

Nasal glial heterotopia (NGH) is a rare benign tumor of the median line. We describe the case of a child presenting a lateral nasal mass. The characteristics of the prenatal ultrasound and the postnatal clinical examination argued in favor of a congenital hemangioma (CH). The MRI performed at 6 weeks of life suggested glial heterotopia. This diagnosis was confirmed by the pathological analysis. Congenital hemangiomas and nasal glial heterotopies have similar clinical presentations. Prenatal ultrasound diagnosis between NGH and CH is difficult. Fetal MRI is not yet highly specific for these two lesions, but it can eliminate an intracerebral connection in cases of NGH. Postnatal exams are more specific. Flow on the Doppler exam is rapid for CH and slow for NGH. On MRI, these two lesions appear as a hypersignal on T2-weighted sequences, but less intense for NGH than for CH. Distinguishing between NGH and CH can be difficult. This does not have a direct incidence on treatment because it is surgical in both cases.

Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years

AIM

The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes.

METHODS

PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used.

RESULTS

A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%.

CONCLUSION

Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good prognosis.

Prenatal Diagnosis of Nasal Glioma Associated with Metopic Craniosynostosis: Case Report and Review of the Literature

Nasal gliomas (nasal glial heterotopia) are rare benign congenital frontonasal lesions occurring in approximately 1:20.000-40,000 live births. The diagnosis is rarely reported prenatally. Nasal gliomas are typically isolated lesions, with syndromic association being exceedingly rare. Metopic craniosynostosis can occur as an isolated abnormality or in association with multiple syndromes. This case is the first reported case of nasal glioma in association with craniosynostosis in the published literature.

Prenatal diagnosis and management of nasal glioma

Advances in foetal imaging have increased our detection rate of craniofacial abnormalities in utero. Nasal glioma is a rare, benign, congenital facial defect. Once detected, further imaging is required to assess for intracranial communication, the presence of additional defects, determine the patency of the aerodigestive tract and decide on timing of delivery. The authors review the current literature on diagnosis and management of nasal glioma in this rapidly advancing field of craniofacial anomalies detected in utero. Literature search of EMBASE and MEDLINE databases yielded 594 articles, which were screened by 2 independent reviewers. A total of 7 papers were selected after exclusion. There have been seven cases of prenatally diagnosed nasal glioma. The earliest of these was detected at 20 wk gestation. The majority were investigated with foetal magnetic resonance imaging (MRI) to establish any intracranial communication or bony defects. Ultrasound monitoring, doppler waveform and 3D rendered images were utilised to delineate the lesion, monitor growth and differentiate potential diagnosis. Postnatal MRI is favoured by most to re-evaluate the lesion and aid surgical planning. Surgical resection was performed within the first few months of life. Diagnostic uncertainty was seen in all cases, until formal histology was obtained, emphasising the challenges, and need for early appropriate specialist input. Whilst the prenatal detection of craniofacial abnormalities increases, there remain diagnostic challenges in differentiating prenatal congenital midfacial defects in utero. These defects are best investigated and monitored using prenatal ultrasound and MRI, to narrow the differential diagnosis, guide timing of delivery and allow for appropriate surgical planning. Prenatally detected nasal glioma, may only be confirmed on histology and families must be counselled appropriately to prepare them for the possible alternative diagnoses. Early surgical resection was undertaken to achieve more favourable aesthetic outcomes, reduce complications of ocular development and provide definitive histological diagnosis.