Prenatal diagnosis of fetal brain arteriovenous malformation: The use of color doppler imaging

Abstract

Color Doppler imaging is a noninvasive modality that can depict the anatomy and direction of blood flow within the fetal and neonatal intracranial circulation.' This capability makes this a most appealing method for the in-utero diagnosis of fetal arteriovenous malformations (AVM). Cerebral arteriovenous malformations with aneurysm of the vein of Galen are rare congenital anatomical anomalies usually associated with severe hemodynamic and CNS disturbances.2 We report the prenatal diagnosis of AVM of the vein of Galen with the combined use of color Doppler and real-time ultrasound imaging. CASE REPORTA 38-year-old patient, gravida 3, para 2, was referred at 38 weeks, menstrual age, for ultrasound examination and estimation of fetal weight. The pregnancy course was uneventful. A preliminary ultrasound examination, performed in the 22nd week, did not reveal any anatomical malformations.At 38 weeks, transabdominal real-time scanning (ECI-1000, 3.5 MHz, Elscint) of the fetal head showed, in high transverse section, a saccular structure (1.96 cm) in the midline (Figure 1). There were no signs of dilatation in the lateral ventricles and no other fetal malformations were observed.Transabdominal scanning of the fetal brain with color Doppler imaging (Acuson 5MHz) demonstrated the same anomalous structure, but At 40 weeks, a 3.6 Kg male neonate was delivered spontaneously. After a stable hemodynamic state, which lasted 22 hours, signs of cardiac failure associated with hernodynamic pre-shock crisis were observed. Brain CT scanning on the same day showed massive dilatation of the vein of Galen (Figure 3). These radiologic postnatal findings were interpreted as compatible with the

Prenatal diagnosis of vein of Galen aneurysmal malformation: report of two cases with proposal for prognostic indices

“…Most of the data concerning VGAM emanate from the neonatal literature. However, with the recent widespread use of routine fetal ultrasonographic examinations, prenatal diagnosis of VGAM is being increasingly reported (Reiter et al, 1986;Pellegrino et al, 1987;Jeanty et al, 1990;Evans and Twining, 1991;Ishimatsu et al, 1991;Dan et al, 1992;Rodesch et al, 1994;Dóren et al, 1995;Sepulveda et al, 1995). The overall prognosis of neonates with VGAM depends on several factors, such as the degree of congestive heart failure (CHF), the angioanatomy of the malformation, its afferent supply, and the venous drainage.…”

Neonatal and Fetal Brain Malformations

“…Spectral analysis may also show arterial-type (WORSWICK 1992) or turbulent flow (BALLESTER 1994;ISHIMATSU 1991;DAN 1992) in the aneurysmal cystic structure.…”