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Anomalies of the Posterior Fossa and the Spinal Cord- Fetal MRI

XIX SYMPOSIUM NEURORAGIOLOGICUM BOLOGNA OCTOBER 4-9, 2010. Anomalies of the Posterior Fossa and the Spinal Cord- Fetal MRI. Chen Hoffmann, MD Neuroradiology Sheba Medical Center, Israel Affiliated to Tel-Aviv University. Indications. Ventricular dilatation Ventricular asymmetry

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Anomalies of the Posterior Fossa and the Spinal Cord- Fetal MRI

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  1. XIX SYMPOSIUM NEURORAGIOLOGICUM BOLOGNA OCTOBER 4-9, 2010 Anomalies of the Posterior Fossa and the Spinal Cord- Fetal MRI Chen Hoffmann, MD Neuroradiology Sheba Medical Center, Israel Affiliated to Tel-Aviv University

  2. Indications • Ventricular dilatation • Ventricular asymmetry • Malformations • Disease found in siblings in previous pregnancies • Vascular malformations • Infectious diseases

  3. Indications (cont’) • US is the first imaging of choice • When US is abnormal the MR is done to verify the diagnosis and to identify additional malformations • US can be suboptimal (head position) • Vermis is formed by 18 weeks GA

  4. Anomalies of the Posterior Fossa • Small PF (Chiari II) • Cystic anomalies (Dandy-Walker, arachnoid cyst, mega cisterna magna) • Others (rhombencephalosynapsis, Walker Warburg syn., vascular)

  5. Myelomeningocele + Chiari II © Erin S. Schwartz, CHOP

  6. Chiari II • Small PF • Downward herniation of cerebellum and brainstem • Cervicomedullary kink • 4th ventricle elongated with no posterior point • Open dysraphism (MMC) in 100%

  7. 22w GA: Chiari II & Myelomeningocele on US © Orit Glenn, UCSF Postnatal MRI: In Utero Repair

  8. Missed MMC • 33 weeks GA • Ventricular dilatation • Partial agenesis of corpus callosum • No associated anomalies known • After birth- MMC! • Only one image showed a cystic mass not in the midline

  9. Differential Diagnosis: Sacrococcygeal Teratoma

  10. Differential Diagnosis: Currarino Syndrome

  11. Suspected Chiari III

  12. Cranial Meningoencephalocele Post natal US axial sagital

  13. Cranial Meningoencephalocele Pre OP © Liat Ben Sira, TAMC

  14. Cranial Meningoencephalocele Post OP MR Post op PF Diastemat. Bone anomm.

  15. 22w GA: Lumbar spine bony anomaly on US © Orit Glenn, UCSF

  16. Postnatal MRI at one day of age confirms findings of fetal MRI Dx: segmental spinal dysgenesis

  17. Cystic Anomalies • Dandy walker malformation • Blake’s pouch • Arachnoid cyst • Mega cisterna magna

  18. Dandy-Walker Complex • Dandy-Walker Complex • Tentorium elevated • Posterior fossa is enlarged • Hypo genetic vermis and anti-clockwise rotated • Brainstem compressed

  19. Dandy-Walker Complex • The cerebellar hemispheres • are dysplastic • The 4th ventricle is opened to • the cisterna magna

  20. Blake’s Pouch • 22 weeks GA • Large PF • Lower part of the vermis is not formed • Posterior part of the 4th ventricle is open to the cisterna magna

  21. Arachnoid Cyst • A cystic lesion posterior to the cerebellum • Vermis is intact • A thin septum between the cyst and the cisterna magna

  22. Others

  23. Walker-Warburg Syn. Age of 1 week

  24. Rombencephalosynapsis • Fused cereballar hemispheres • Absent vermis • Absent primary fissure • Narrow 4th ventricle in Ax plane (key hole shape) • +/- septo-optic dysplasia

  25. 29w GA: Post. Fossa Mass on US, ? Subdural © Orit Glenn, UCSF

  26. 31w GA: Follow-up MRI Dx: dural sinus malformation

  27. Vein of Gallen Malformation A-V fistula between deep choroidal arteries and the median prosencephalic vein Of Markovski

  28. The Chaim Sheba Medical Center Tel Hashomer, Israel Chen.hoffmann@sheba.health.gov.il

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