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Bedei I, Krispin E, Sanz Cortes M, Lombaard H, Zemet R, Whitehead WE, Belfort MA, Huisman TAGM. Prenatal diagnosis and postnatal outcome of closed spinal dysraphism. Prenat Diagn 2024; 44:499-510. [PMID: 38013494 DOI: 10.1002/pd.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/01/2023] [Accepted: 10/15/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To evaluate the prenatal diagnosis of closed dysraphism (CD) and its correlation with postnatal findings and neonatal adverse outcomes. METHODS A retrospective cohort study including pregnancies diagsnosed with fetal CD by prenatal ultrasound (US) and magnetic resonance imaging (MRI) at a single tertiary center between September 2011 and July 2021. RESULTS CD was diagnosed prenatally and confirmed postnatally in 12 fetuses. The mean gestational age of prenatal imaging was 24.2 weeks, in 17% the head circumference was ≤fifth percentile and in 25% the cerebellar diameter was ≤fifth percentile. US findings included banana sign in 17%, and lemon sign in 33%. On MRI, posterior fossa anomalies were seen in 33% of cases, with hindbrain herniation below the foramen magnum in two cases. Mean clivus-supraocciput angle (CSA) was 74°. Additional anomalies outside the CNS were observed in 50%. Abnormal foot position was demonstrated prenatally in 17%. Neurogenic bladder was present in 90% of patients after birth. CONCLUSION Arnold Chiari II malformation and impaired motor function can be present on prenatal imaging of fetuses with CD and may be associated with a specific type of CD. Prenatal distinction of CD can be challenging. Associated extra CNS anomalies are frequent and the rate of neurogenic urinary tract dysfunction is high.
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Affiliation(s)
- Ivonne Bedei
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University, Giessen, Germany
- Baylor College of Medicine Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Eyal Krispin
- Boston Children's Hospital, Brigham and Women's Hospital, Beth Israel Deacones Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Magdalena Sanz Cortes
- Baylor College of Medicine Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Hennie Lombaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Roni Zemet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - William E Whitehead
- Department of Neurosurgery, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA
| | - Michael A Belfort
- Baylor College of Medicine Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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Mufti N, Sacco A, Aertsen M, Ushakov F, Ourselin S, Thomson D, Deprest J, Melbourne A, David AL. What brain abnormalities can magnetic resonance imaging detect in foetal and early neonatal spina bifida: a systematic review. Neuroradiology 2022; 64:233-245. [PMID: 34792623 PMCID: PMC8789702 DOI: 10.1007/s00234-021-02853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound. METHODS Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible. RESULTS Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse. CONCLUSION MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Adalina Sacco
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Fred Ushakov
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Sebastian Ourselin
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Dominic Thomson
- Paediatric Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, London, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit (KU) Leuven, Leuven, Belgium
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Nagaraj UD, Bierbrauer KS, Stevenson CB, Peiro JL, Lim FY, Habli MA, Kline-Fath BM. Prenatal and postnatal MRI findings in open spinal dysraphism following intrauterine repair via open versus fetoscopic surgical techniques. Prenat Diagn 2019; 40:49-57. [PMID: 31351017 DOI: 10.1002/pd.5540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study is to examine MRI findings of the brain and spine on prenatal and postnatal MRI following intrauterine repair of open spinal dysraphism (OSD) by open hysterotomy and fetoscopic approaches. MATERIALS AND METHODS This study is a single-center HIPAA-compliant and IRB-approved retrospective analysis of fetal MRIs with open spinal dysraphism from January 2011 through December 2018 that underwent subsequent prenatal repair of OSD. RESULTS Sixty-two patients met inclusion criteria: 47 underwent open repair, and 15 underwent fetoscopic repair, with an average gestational age of 22.6 ± 1.4 weeks at initial MRI. On postnatal MRI, spinal cord syrinx was seen in 34% (16/47) of patients undergoing open versus 33.3% (5/15) undergoing fetoscopic repair (P = 0.96). Postnatally, there was no significant difference in hindbrain herniation between the open versus fetoscopic repair groups (P = 0.28). Lateral ventricular size was significantly larger in the open (20.9 ± 6.7 mm) versus the fetoscopic repair (16.1 ± 4.9 mm) group (P = 0.01). CONCLUSION Though lateral ventricular size in the open repair group was larger than the fetoscopic repair group, this can likely be explained by initial selection criteria used for fetoscopic repair. Other postoperative imaging parameters on postnatal MRI were not significantly different between the two groups.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Karin S Bierbrauer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charles B Stevenson
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jose L Peiro
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Foong Yen Lim
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mounira A Habli
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Maternal-Fetal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Warner HM, Batty R, Warner FM, Fanou EM, Griffiths PD. T2 prolongation in the cerebellar vermis on prenatal MRI of fetuses with Chiari 2 malformations. Clin Radiol 2019; 74:408.e19-408.e25. [PMID: 30824110 DOI: 10.1016/j.crad.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/15/2019] [Indexed: 11/16/2022]
Abstract
AIM To describe a new finding in fetuses with Chiari 2 malformations recognised at in utero (iu) magnetic resonance imaging (MRI), specifically T2 prolongation (high signal) in the cerebellar vermis. MATERIALS AND METHODS This was a prospective observational study of iuMRI studies performed at two time points on 20 fetuses with Chiari 2 malformations and 10 control fetuses at the same time points. High T2 signal in the cerebellar vermis was noted and correlated with posterior fossa dimensions was assessed. RESULTS High T2 signal in the cerebellar vermis was found in over half of the fetuses with a Chiari 2 malformation, but was not correlated with the degree of reduction in size of the bony posterior fossa. CONCLUSION The present findings suggest that abnormal high T2 signal in the cerebellum is common in fetuses with Chiari 2 malformations and although the cause of the signal change is not known at present it may represent vasogenic oedema as a result of restricted venous drainage.
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Affiliation(s)
- H M Warner
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK; Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - R Batty
- Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - F M Warner
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - E M Fanou
- Department of Neuroradiology, Atkinson Morley Ward, St George's Hospital, London, UK
| | - P D Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
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Wang L, Nie H, Wang Q, Zhang G, Li G, Bai L, Hua T, Wei S. Use of magnetic resonance imaging combined with gene analysis for the diagnosis of fetal congenital heart disease. BMC Med Imaging 2019; 19:12. [PMID: 30683072 PMCID: PMC6347844 DOI: 10.1186/s12880-019-0314-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/16/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Fetal deformity is a disease caused by abnormal chromosome structure, which may be influenced by genetic factors as well as the maternal and external environment. Magnetic resonance imaging (MRI) may be used to effectively diagnose fetus deformities. However it has been reported that gene analysis is a more accurate diagnostic method. The aim of the present study was to investigate the effectiveness of MRI in combination with gene analysis for the diagnosis of fetal congenital heart disease, a form of fetus deformity. METHODS MRI, array comparative genome hybridization analysis and fluorescence in situ hybridization were used to analyze the effectiveness of the two methods in a total of 78 pregnant women with suspected fetal congenital heart disease. RESULTS Our findings demonstrated that the combination of MRI and gene analysis resulted in significantly improved diagnostic accuracy, sensitivity and specificity for fetal congenital heart disease compared with either method alone. MRI combined with gene analysis confirmed 42 fetuses with pulmonary stenosis, 24 with aortic stenosis and 12 healthy fetuses, which was significantly improved compared with MRI or gene analysis alone. It was also observed that gene analysis was a more efficient method of diagnosis compared with MRI; however, the combination of the two methods was the most effective. CONCLUSION In conclusion, the results of the present study suggest that MRI combined with gene analysis may be a more effective diagnostic method for fetal congenital heart disease compared with the current protocol.
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Affiliation(s)
- Lishun Wang
- Department of Radiology, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, 066000, People's Republic of China.
| | - Hongyan Nie
- Department of Ultrasound, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Qichen Wang
- Department of Radiology, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Guoliang Zhang
- Department of Radiology, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Gang Li
- Department of Anesthesiology, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, qinhuangdao, Hebei, 066000, People's Republic of China
| | - Liwei Bai
- Prenatal Diagnosis Center, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Tianshu Hua
- Department of Epigenetics, Maternity and Child Care Center of Qinhuangdao, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Shuzhang Wei
- Department of Radiology, Maternity and Child Care Center of Liuzhou, Liuzhou, Guangxi Zhuang Autonomous Region, 545000, People's Republic of China
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Rethmann C, Scheer I, Meuli M, Mazzone L, Moehrlen U, Kellenberger CJ. Evolution of posterior fossa and brain morphology after in utero repair of open neural tube defects assessed by MRI. Eur Radiol 2017; 27:4571-4580. [DOI: 10.1007/s00330-017-4807-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
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Nagaraj UD, Bierbrauer KS, Zhang B, Peiro JL, Kline-Fath BM. Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI. AJNR Am J Neuroradiol 2017; 38:1031-1036. [PMID: 28279990 DOI: 10.3174/ajnr.a5116] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/19/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE As the practice of in utero repair of myelomeningoceles becomes more prevalent, knowledge of the expected MR imaging findings has become increasingly important. Our aim was to examine neuroimaging findings with a focus on hindbrain herniation and ventricular size in fetuses with open spinal dysraphism and to compare them with postnatal imaging features in groups undergoing prenatal-versus-postnatal repair. MATERIALS AND METHODS Single-center retrospective analysis was performed on MRIs of fetuses with open spinal dysraphism from January 2004 through July 2015 with available postnatal imaging. One hundred two fetuses were included. Reports from available fetal ultrasound were also examined. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Descriptive analyses were performed to demonstrate the distribution of the imaging findings. RESULTS Thirty-two of 102 (31.3%) fetuses underwent in utero repair of open spinal dysraphism; 68.6% (70/102) underwent postnatal repair. Ninety-four of 102 (92.2%) fetuses had cerebellar ectopia. Of those who underwent prenatal repair (26 grade 3, 6 grade 2), 81.3% (26/32) had resolved cerebellar ectopia postnatally. Of those who had severe cerebellar ectopia (grade 3) that underwent postnatal repair, 65.5% (36/55) remained grade 3, while the remaining 34.5% (19/55) improved to grade 2. The degree of postnatal lateral ventriculomegaly in those that underwent prenatal repair (20.3 ± 5.6 mm) was not significantly different from that in those that underwent postnatal repair (21.5 ± 10.2 mm, P = .53). Increased Chiari grade was significantly correlated with decreased head size for gestational age on fetal sonography (P = .0054). CONCLUSIONS In fetuses with open spinal dysraphism and severe Chiari II malformation that do not undergo prenatal repair, most have no change in the severity of cerebellar ectopia/Chiari grade. However, in fetuses that undergo in utero repair, most have resolved cerebellar ectopia postnatally.
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Affiliation(s)
- U D Nagaraj
- University of Cincinnati College of Medicine (U.D.N., K.S.B., B.Z., J.L.P., B.M.K.-F.), Cincinnati, Ohio.
| | - K S Bierbrauer
- Department of Pediatric Neurosurgery (K.S.B.).,University of Cincinnati College of Medicine (U.D.N., K.S.B., B.Z., J.L.P., B.M.K.-F.), Cincinnati, Ohio
| | - B Zhang
- From the Department of Radiology and Medical Imaging (B.Z., B.M.K.-F.).,Division of Biostatistics and Epidemiology (B.Z.).,University of Cincinnati College of Medicine (U.D.N., K.S.B., B.Z., J.L.P., B.M.K.-F.), Cincinnati, Ohio
| | - J L Peiro
- Department of Pediatric Surgery (J.L.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine (U.D.N., K.S.B., B.Z., J.L.P., B.M.K.-F.), Cincinnati, Ohio
| | - B M Kline-Fath
- From the Department of Radiology and Medical Imaging (B.Z., B.M.K.-F.).,University of Cincinnati College of Medicine (U.D.N., K.S.B., B.Z., J.L.P., B.M.K.-F.), Cincinnati, Ohio
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Stenogyria — Not only in Chiari II malformation. J Neurol Sci 2014; 347:337-40. [DOI: 10.1016/j.jns.2014.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/07/2014] [Accepted: 09/15/2014] [Indexed: 11/23/2022]
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Chen JA, Lazareff JA. Correction of Chiari malformation due to closure of a concomitant thoracic meningocele. Childs Nerv Syst 2014; 30:531-4. [PMID: 23921850 DOI: 10.1007/s00381-013-2250-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Chiari malformations are characterized by hindbrain herniation. Historically, some types have been linked to neural tube defects, but the causal relationship between the two conditions is still unclear. CASE REPORT We report on a full-term male neonate with a prenatally diagnosed posterior thoracic meningocele, whose MRI demonstrated Chiari malformation. The meningocele was closed in the second week of life. The Chiari-related symptoms rapidly improved following surgery. Postoperative MRI at 7 months of age showed ascent of the cerebellar tonsils to a normal position. DISCUSSION This case suggests that the traction on the cerebellum by a fixed spinal cord may play a role in the pathogenesis of the multifaceted Chiari malformations.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, 18-210 Semel, Box 957039, Los Angeles, CA, 90095-7039, USA,
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