Supratentorial Abnormalities in the Chiari II Malformation, I

Callen, Andrew L.; Filly, Roy A.

doi:10.7863/jum.2008.27.1.33

Cited by 21 publications

(19 citation statements)

References 13 publications

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“…15 Ventriculomegaly may be absent, particularly before 24 weeks, and is associated with many conditions other than MMC. 16 However, there are multiple supratentorial features of the Chiari II malformation, 9,10 as previously published in this trilogy, that can also be visualized on prenatal sonograms. Recognition of supratentorial features is highly suggestive of the presence of MMC and greatly aids in suspecting this diagnosis.…”

Section: Discussionmentioning

confidence: 61%

“…This article is the third in a series of sonographic observations that we had noted in fetuses with MMC and the accompanying Chiari II malformation. 9,10 Our clinical observations indicated to us that interhemispheric cysts were particularly common in fetuses that had Chiari II malformations. Interhemispheric cysts can be seen in a variety of both "normal" and abnormal circumstances in fetuses.…”

mentioning

confidence: 55%

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Supratentorial Abnormalities in the Chiari II Malformation, III

Wong

Barkovich

Callen

et al. 2009

J of Ultrasound Medicine

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Section: Discussionmentioning

confidence: 61%

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confidence: 55%

Supratentorial Abnormalities in the Chiari II Malformation, III

Wong

Barkovich

Callen

et al. 2009

J of Ultrasound Medicine

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“…The shape of the lateral ventricular dilation as observed by sonography may also provide an important diagnostic clue for the presence of the Chiari II malformation. Callen and Filly [29] described that the tip of the occipital horn of the lateral ventricles had a pointed shape on the axial view in 70% of fetuses that proved to have SB and was noted irrespective of coexisting VM (fig. 22).…”

Section: Cranial Findings In Spinal Dysraphismmentioning

confidence: 99%

“…Fujisawa et al [30] also noted that among second-trimester fetuses with VM, a triangular configuration of the occipital horn as observed on coronal TA and TV sonography was helpful in distinguishing VM due to neural tube defects from other central nervous system anomalies. Despite the common presence of VM in SB, microcephaly, defined as a head circumference measurement less than the 10th percentile for gestational age, is also a commonly noted feature of this condition, present in up to 70% of fetuses [17,18,29] (fig. 23).…”

Section: Cranial Findings In Spinal Dysraphismmentioning

confidence: 99%

The Diagnostic Features of Spina Bifida: The Role of Ultrasound

Coleman

Langer

Horii³

2014

Fetal Diagn Ther

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Myelomeningocele (MMC) is one of the most devastating, nonlethal congenital anomalies worldwide. The live birth prevalence of MMC changed dramatically in the 1980s with the introduction of maternal serum screening and the widespread use of prenatal ultrasound imaging. The high-resolution ultrasound affordable today with state-of-the-art equipment allows us to make a very accurate diagnosis of MMC, including details related to the entire fetal central nervous system. Ultrasound can accurately localize the site of the osseous and soft tissue defects. Congenital spinal defects can be characterized definitively as open or closed, which are treated very differently with in utero repair, which is done in some cases, compared to only conservative follow-up with postnatal therapy for occult defects. Additional findings of kyphosis, scoliosis and anomalous vertebrate and associated conditions such as cervical syrinx can be identified. The state of the intracranial structures, including the presence or absence of ventriculomegaly and hindbrain herniation, as well as unexpected complications such as intracranial hemorrhage can be diagnosed. The severity of neurological compromise in some fetuses can be estimated by detailed examination of the lower extremities. As well as searching for talipes, we also now routinely characterize flexion and extension motions at the hip, knee and ankle joints. The information provided by ultrasound plays a crucial role, now more than ever, in patient counseling and pregnancy management. This article emphasizes how we utilize ultrasound in the evaluation of patients with suspected MMC at the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia.

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“…In the first article of this series, we described a supratentorial finding that has received scant attention in the sonographic literature, the ventricular "point," a misshapen occipital horn that is pointed rather than rounded. 5 In this article, we address tectal morphologic abnormalities. The normal tectum has a rounded or, sometimes, a squared appearance of the colliculi and a short cranial caudal length (Figure 1).…”

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confidence: 99%

Supratentorial Abnormalities in the Chiari II Malformation, II

Callen

Stengel²,

Filly³

2009

J of Ultrasound Medicine

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Objective. The sonographic diagnosis of fetal myelomeningocele has improved mainly because the diagnostic focus has shifted from observation of spinal manifestations to observation of cranial abnormalities. Intracranial diagnostic criteria rely on abnormalities in the posterior fossa. We describe abnormalities in tectal morphologic characteristics that, although well described on magnetic resonance imaging, have received little attention in the sonographic literature. This study analyzed the frequency of this observation and technical aspects that improve its visualization. Methods. From a database of obstetric sonograms, we identified all cases of sonographically detected myelomeningocele. The search covered the years 1999 to 2007. We retrospectively reviewed the fetal intracranial findings with special attention to elongation or "beaking" of the tectum. Results. A total of 89 fetuses were identified. The mean and median gestational ages were 22 weeks 4 days and 22 weeks 2 days, respectively. Of the 89 cases, 59 (66%) had an abnormal tectal shape. The abnormality was seen in 77% of cases judged to be suboptimally visualized and 62% of cases with good visualization. Tectal abnormalities were seen equally well in fetuses before and after 24 weeks. Finally, tectal abnormalities were seen more frequently as the severity of posterior fossa findings increased. Conclusions. Tectal morphologic alteration is a common supratentorial feature of the Chiari II malformation on prenatal sonography both before and after 24 weeks' gestation. Its frequency increases with the severity of posterior fossa abnormalities. Therefore, it may be useful as a supratentorial indicator of both the presence and, potentially, the severity of the Chiari II malformation. Key words: Chiari II malformation; fetal sonography; myelomeningocele; tectum shape. Abbreviations MRI, magnetic resonance imaginghe features of the Chiari II malformation that have proven to be most useful and have received the most attention in the sonographic literature are the infratentorial findings. These include effacement of the cisterna magna and deformation of the cerebellum, known as the "banana" sign.1 Other infratentorial abnormalities are commonly observed postnatally.2 Although the dominant features of the Chiari II malformation relate to the hindbrain, many supratentorial features have been described.2,3 Because posterior fossa manifestations of the Chiari II malformation can be obscured in severe cases because of shadowing from the petrous ridges, 1,4 our goal in this series has been to identify the sonographic appearance and frequency of supratentorial findings that can provide the interpreting physician with clues to the diagnosis of the Chiari II malformation in cases in which the posterior fossa is poorly visualized.

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Supratentorial Abnormalities in the Chiari II Malformation, I

Cited by 21 publications

References 13 publications

Supratentorial Abnormalities in the Chiari II Malformation, III

Supratentorial Abnormalities in the Chiari II Malformation, III

The Diagnostic Features of Spina Bifida: The Role of Ultrasound

Supratentorial Abnormalities in the Chiari II Malformation, II

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