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Sonography of the fetal neural axis: a practical approach

Published online by Cambridge University Press:  10 October 2008

Ruth B Goldstein*
Affiliation:
Department of Radiology, University of California San Francisco, California, USA.
*
Address for correspondence: Dept of Radiology, 513 Parnassus Ave, Room S358, University of California, San Francisco, CA 94143-0628, USA.

Extract

Among serious fetal anomalies currently detectable with ultrasound, defects of the central nervous system (CNS) are among the most common. These congenital anomalies are especially likely to burden not only affected children with severely limiting handicaps, but also their families with long-lasting anguish and financial responsibility. It is appropriate that interest in methods for improving prenatal detection of these abnormalities has intensified. Alphafetoprotein screening programmes are now widely available, and many papers have been written describing useful sonographic observations that enhance prenatal diagnosis. As a consequence, the majority of the most common serious neural axis defects including fetal hydrocephalus, anencephaly, myelomeningocele and encephalocele, previously detected almost exclusively at birth, today can be accurately detected prenatally. A few observations in the fetal brain and spine have proven to be especially useful in this task. This article presents a simplified and effective approach to the general sonographic survey of the neural axis in fetuses at average and increased risk for these anomalies. The aim is to improve not only accuracy of diagnosis of CNS malformations, but the efficiency and confidence of the examiner.

Type
Articles
Copyright
Copyright © Cambridge University Press 1995

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References

1Chervenak, FA, Berkowitz, RL, Tortora, M, Hobbins, JC. The management of fetal hydrocephalus. Am J Obstet Gynecol 1985; 151: 933–42.CrossRefGoogle ScholarPubMed
2Cochrane, DD, Myles, ST, Nimrod, C, Still, DK, Sugarman, RD, Wittmann, BK. Intrauterine hydrocephalus and ventriculomegaly: association anomalies and fetal outcome. Can J Neural Sci 1985; 12: 5159.CrossRefGoogle ScholarPubMed
3Pretorius, DH, Davis, K, Manco-Johnson, ML, Manchester, D, Meier, PR, Clewell, WH. Clinical course of fetal hydrocephalus: 40 cases. AJR 1985; 144: 827–31.CrossRefGoogle ScholarPubMed
4Pilu, G, Rizzo, N, Orsini, LF, Bovicelli, L. Antenatal recognition of cerebral anomalies. Ultrasound Med Biol 1986; 12: 319–26.CrossRefGoogle ScholarPubMed
5Serlo, W, Kirkinen, P, Jouppila, P, Herva, R. Prognostic signs in fetal hydrocephalus. Childs Nerv Syst 1986; 2: 9397.CrossRefGoogle ScholarPubMed
6Nyberg, DA, Mack, LA, Hirsch, J, Pagon, RP, Shepard, TH. Fetal hydrocephalus: sonographic detection and clinical significance of associated anomalies. Radiology 1987; 163: 187–91.CrossRefGoogle ScholarPubMed
7Vintzileos, AM, Campbell, WA, Weinbaum, PJ, Nocimson, DJ. Perinatal management and outcome of fetal ventriculomegaly. Obstet Gynecol 1987; 69: 511.Google ScholarPubMed
8Hudgins, RJ, Edwards, MSB, Goldstein, RB, Callen, PW, Harrison, MR, Filly, RA et al. Natural history of fetal ventriculomegaly. Pediatrics 1988; 82: 692–97.CrossRefGoogle ScholarPubMed
9Drugan, A, Krause, B, Vanady, A, Zador, IE, Sacks, AJ, Evans, MI. The natural history of prenatally diagnosed cerebral ventriculomegaly. JAMA 1989; 261: 1785–88.CrossRefGoogle ScholarPubMed
10Goldstein, RB, La Pidus, AS, Filly, R, Cardoza, J. Mild lateral cerebral ventricular dilatation in utero: clinical significance and prognosis. Radiology 1990; 176: 237–42.CrossRefGoogle ScholarPubMed
11Nicolaides, KH, Berry, S, Snijders, RJM, Thorpe-Beeston, JG, Gosden, C. Fetal lateral cerebral ventriculomegaly: associated malformations and chromosomal defects. Fetal Diagn Ther 1990; 5: 514.CrossRefGoogle ScholarPubMed
12Twining, P, Jaspan, T, Zuccollo, J. The outcome of fetal ventriculomegaly. Br J Radial 1994; 67: 2631.CrossRefGoogle ScholarPubMed
13Chervenak, FA, Duncan, C, Ment, LR, Hobbins, JC, McClure, M, Scott, D et al. Outcome of fetal ventriculomegaly. Lancet 1984; 2: 179–81.Google Scholar
14Clewell, WH, Meier, PR, Manchester, DK, Manco-Johnson, ML, Pretorius, DH, Hendee, RW. Ventriculomegaly: evaluation and management. Semin Perinatal 1985; 9: 98102.Google ScholarPubMed
15Roberts, AB, Hampton, E, Wilson, N. Ultrasound detection of fetal structural abnormalities in Auckland 1988–89. NZMedJ 1993; 106: 441–43.Google Scholar
16Goldstein, RB, La Pidus, AS, Filly, RA, Cardoza, J. Mild lateral cerebral ventricular dilatation in utero: clinical significance and prognosis. Radiology 1990; 176: 237–42.CrossRefGoogle ScholarPubMed
17Amato, M, Huppi, P, Durig, P, Kaiser, G, Schneider, H. Fetal ventriculomegaly due to isolated brain malformations. Neuropediatrics 1990; 21: 130–32.CrossRefGoogle ScholarPubMed
18Cardoza, JD, Filly, RA, Podrasky, AE. The dangling choroid plexus: a sonographic observation of value in excluding ventriculomegaly. AJR 1988; 151: 767–70.CrossRefGoogle ScholarPubMed
19Goldstein, I, Reece, EA, Pilu, GL, Hobbins, JC. Sonographic evaluation of the normal developmental anatomy of fetal cerebral ventricles IV: the posterior horn. Am J Perinatal 1990; 7: 7983.CrossRefGoogle ScholarPubMed
20Siedler, DE, Filly, RA. Relative growth of higher fetal brain structures. J Ultrasound Med 1987; 6: 573–76.CrossRefGoogle ScholarPubMed
21Heiserman, J, Filly, RA, Goldstein, RB. Effect of measurement errors on sonographic evaluation of ventriculomegaly. J Ultrasound Med 1991; 10: 121–24.Google Scholar
22Bromley, B, Frigoletto, D Jr, Benacerraf, BR. Mild fetal lateral cerebral ventriculomegaly: clinical course and outcome. Am J Obstet Gynecol 1991; 164: 863–67.CrossRefGoogle ScholarPubMed
23Patel, MD, Filly, AL, Hersh, DR, Goldstein, RB. Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome. Radiology 1994; 192: 759–64.CrossRefGoogle ScholarPubMed
24Mahony, BS, Nyberg, DA, Hirsch, JH, Petty, CN, Hendricks, SK, Mack, LA. Mild idiopathic lateral cerebral ventricular dilatation in utero: sonographic evaluation. Radiology 1988; 169: 715–21.CrossRefGoogle ScholarPubMed
25Rosseau, GL, McCullough, DC, Joseph, AL. Current prognosis in fetal ventriculomegaly. J Neurosurg 1992; 77: 551–55.CrossRefGoogle ScholarPubMed
26Mahony, BS, Callen, PW, Filly, RA, Hoddick, WK. The fetal cisterna magna. Radiology 1984; 153: 773–76.CrossRefGoogle ScholarPubMed
27Filly, RA, Cardoza, JD, Goldstein, RB, Barkovich, AJ. Detection of fetal CNS anomalies: a practical level of effort for a “routine” sonogram. Radiology 1989; 172: 403408.CrossRefGoogle ScholarPubMed
28Goldstein, RB, Podrasky, AE, Filly, RA, Callen, PW. Effacement of the fetal cisterna magna in association with myelomeningocele. Radiology 1989; 172: 409–13.CrossRefGoogle ScholarPubMed
29Pretorius, DH, Kallman, CE, Grafe, MR, Budorick, NE, Stamm, ER. Linear echoes in the fetal cisterna magna. J Ultrasound Med 1992; 11: 125–28.CrossRefGoogle ScholarPubMed
30Knutzon, RK, McGahan, JP, Salamat, MS, Brant, WE. Fetal cisterna magna septa: a normal anatomic finding. Radiology 1991; 180: 799801.CrossRefGoogle ScholarPubMed
31Emery, JL, MacKenzie, N. Medullo-cervical dislocation deformity (Chiari II deformity) related to neurospinal dysraphism (meningomyelocele). Brain 1973; 96: 155–62.Google Scholar
32Benacerraf, BR, Stryker, J, Frigoletto, JD Jr. Abnormal US appearance of the cerebellum (banana sign). Indirect sign of spina bifida. Radiology 1989; 171: 151–53.CrossRefGoogle ScholarPubMed
33Nicolaides, KH, Gabbe, SG, Campbell, S, Guidetti, R. Ultrasound screening for spina bifida: cranial and cerebellar signs. Lancet 1986; 2: 7274.CrossRefGoogle ScholarPubMed
34Filly, RA. Fetal neural axis: practical approach to identify anomalous development. Ultrasound Special Course Syllabus of the RSNA 1991: 103–10.Google Scholar
35van den Hof, MC, Nicolaides, KH, Campbell, J, Campbell, S. Evaluation of the lemon and banana signs in one hundred thirty fetuses with open spina bifida. Am J Obstet Gynecol 1990; 162: 322–27.CrossRefGoogle ScholarPubMed
36Babcook, CJ, Goldstein, RB, Barth, RA, Damato, N, Callen, PW, Filly, RA. Prevalence of ventriculomegaly in association with myelomeningocele: the effect of gestational age and severity of the posterior fossa deformity. Radiology 1994; 190: 703707.Google Scholar
37Campbell, J, Gilbert, WM, Nicolaides, KH, Campbell, S. Ultrasound screening for spina bifida: cranial and cerebellar signs in a high-risk population. Obstet Gynecol 1987; 70: 247–50.Google ScholarPubMed
38Ball, RH, Filly, RA, Goldstein, RB, Callen, PW. The lemon sign: not a specific indicator of meningo-myeloceles. J Ultrasound Med 1993; 12: 131–3.Google Scholar
39Kollias, SS, Goldstein, RB, Cogen, PH, Filly, RA. Prenatally detected myelomeningoceles: sonographic accuracy in estimation of the spinal level. Radiology 1992; 185: 109–1.CrossRefGoogle ScholarPubMed
40Babcook, CJ, Goldstein, RB, Filly, RA. Prenatally detected fetal myelomeningoceles: is karyotype analysis warranted? Radiology in press.Google Scholar
41Goldstein, I, Reece, EA, Pilu, G, Boricelli, L, Bobbins, JC. Cerebellar measurements with ultrasonography in the evaluation of fetal growth and development. Am J Obstet Gynecol 1987; 156: 1065–69.CrossRefGoogle ScholarPubMed
42Chang, M, Russell, SA, Callen, PW, Filly, RA, Goldstein, RB. Prognostic implications of detection of inferior vermian agenesis in Dandy-Walker malformations. Radiology 1994; 193:765–70.CrossRefGoogle ScholarPubMed