3–7 September 2006, London, UK
syndrome). After birth three children showed neurological handicaps
in two cases due to postnatally detected syndromes: one Sotos
syndrome and one Goldenhar syndrome and one case related to
progression of the ventriculomegaly.
Conclusions: The outcome of fetuses with isolated mild ventricu-
lomegaly is mostly favorable. Chromosomal anomalies should be
excluded in all cases with MVM since in 4.1% of the fetuses trisomy
21 was proven. The risk for a chromosomal anomaly is higher when
additional soft markers for aneuploidy are present. Previously pub-
lished studies on this topic did not take the role of soft markers into
consideration. In cases with MVM accompanied by normal kary-
otype the risk for prenatal and postnatal mortality and morbidity is
increased as compared to sonographically normal fetuses.
OP03.16
Prenatal detection of thromboses of the dural sinuses: report
of five cases, diagnosis and outcome
H. Laurichesse Delmas1 , N. Winer2 , C. Talmant3 , D. Gallot1 ,
A. Couture4 , F. Geissler1 , A. M. Beaufrere1 , P. J. Dechelotte1 ,
D. Lemery1
1
CHU Clermont Ferrand, France, 2 CHU Nantes, France,
3
Centre d’échographie de l’ile Gloriette Nantes, France,
4
CHU Montpellier, France
We report herein a series of dural sinuses thromboses detected
prenatally (5 cases). Real-time ultrasound associated with color
Doppler was the key stone for to the prenatal diagnosis showing
a hyperechoic area surrounded by a hypoechoic triangular area
and absence of flow inside the mass. Interruption of blood flow
in the thrombosed sinus or visualisation of an enlargement of
the interhemispheral space (dilated superior longitudinal sinus) are
typical associated ultrasound features. The first case diagnosed
at 25 weeks was terminated because of a very large feature and
lack of specific data for counselling the parents. The second and
third cases detected at 23 and 32 weeks presented a thrombosis
of the torcular and the third case observed at 22 weeks presented
three concomitant thromboses (right transverse, longitudinal and
sphenoidal sinuses). Regression of thrombosis was observed during
pregnancies and recanalisation of the transverse sinus was seen
by Color and pulsed Doppler before birth in one case. Neonatal
transfontanellar scan showed a residual clot in the two cases.
At 18 months the three children’s neurodevelopmental assessment
was normal. The fourth case was diagnosed at 30 weeks and the
suspected thrombosis was associated with signs of fetal intolerance
and cardiac insufficiency. In view of poor fetal prognosis parents
opted for TOP. Autopsy revealed a thrombosis of the occipital
dural sinuses associated with an hemangioma. We conclude
that antenatal thrombosis can appear as early as 20 weeks and
favorable outcome is possible if isolated and brain appears
normal (no deep brain thrombosis, ischemic lesion, arteriovenous
malformation or abnormal gyration which can be best ruled out by
MRI).
OP03.17
The cisterna magna septa – a potential new marker for
maldevelopment of the roof of the rhombencephalon
A. J. Robinson1 , R. B. Goldstein2
1
Children’s & Women’s Hospital of British Columbia,
Canada, 2 University of California, San Francisco, United
States
Objective: Linear echoes are normally seen in the developing cisterna
magna. Through sonographic observations in fetuses and neonates,
we previously demonstrated that these septa most likely represent
the remants of Blake’s pouch, a normal dorsal expansion of the roof
of the 4th ventricle into the cisterna magna. We seek to correlate
in what way abnormal configurations of the cisterna magna septa
Ultrasound in Obstetrics & Gynecology 2006; 28: 412–511
Oral poster abstracts
relate to abnormal development of structures arising in the roof of
the rhombencephalic vesicle.
Methods: We performed prospective and retrospective selection of
normal and abnormal posterior fossa sonograms demonstrating
the variability in appearances of the cisterna magna septa,
with follow-up ultrasound, MRI and histopathology where
appropriate.
Results: Observations that will be demonstrated and correlated on
fetal and neonatal cranial sonography, MRI and histopathology
include: 1. The normal formation and sonographic appearances
of Blake’s pouch, at different stages of gestation. 2. The probable
pathology of Blake’s pouch in Dandy-Walker continuum, where
it is associated with cerebellar vermian hypoplasia, posterior fossa
enlargement and variable fenestration. 3. The probable pathology
of Blake’s pouch in mega cisterna magna, where it is associated
with normal vermian morphology, posterior fossa enlargement and
delayed fenestration. 4. The probable pathology of Blake’s pouch
in persistent Blakes’ pouch cyst, where it is associated with normal
vermian morphology, and absent fenestration.
Conclusions: We demonstrate that the cisterna magna septa
probably represent the walls of Blake’s pouch, and our observations
support current opinion that mega-cisterna magna and persistent
Blake’s pouch cyst represent abnormalities within the Dandy-Walker
continuum. The cisterna magna septa are therefore a potential new
marker for developmental anomalies affecting the structures arising
in the roof of the rhombencephalic vesicle, namely the cerebellum,
vermis and Dandy-Walker ‘cyst’.
OP03.18
Brain echogenicities in fetuses at risk for preterm birth
J. I. P. De Vries1 , F. M. F. Rosier-van Dunne1 , G. Van
Wezel-Meijler2
1
VU University Medical Centre, Netherlands, 2 LUMC,
Netherlands
Objective: To study the prevalence of echodensities in periventricular
white matter (PVE), lateral ventricles (IVE), basal ganglia and
thalamus (BGTE) and of ventricular dilatation (VD) in fetuses at
risk for preterm birth.
Methods: In 124 pregnancies complicated by hypertension or
preterm labor, 124 singleton fetuses were examined between
26 and 33 weeks. Echogenicities were classified according van
Gelder-Hasker et al (1). Transfontanellar coronal and sagittal
ultrasonographic (US) imaging was performed at admission,
repeated in 26 and in 107 cases within 24 hours after birth.
Results: Sixty-five percent of the fetuses had echodensities at
admission. Thirty-five fetuses had echogenicities in more than one
area. Seventeen were lost for follow-up. Echodensities in the three
regions of interest and ventricle dilatation in 124 fetuses and 107
neonates are presented in the table.
PVE PVE PVE IVE IVE IVE BGTE BGTE
US moment IA IB II I II III VD diffuse localised
Admission 54 9 2 8 10 5 20 17 18
Last fetal 51 8 2 8 9 4 21 16 17
Neonatal 51 43 7 24 5 2 9 30 7
Conclusions: Echodensities were frequently encountered in the white
matter, lateral ventricles and thalamus/basal ganglia. We think in
the fetus PVE presents white matter injury only if the echogenicity
exceeds that of the choroid plexus. IVE is probably only pathological
if accompanied by VD and BGTE is only pathological if unilateral
and/or localised. Otherwise the echogenicities are explained as
physiological phenomena or transient abnormalities resolved by
the plasticity of the immature brain. (1) Gelder-Hasker MR et al.
Ultrasound Obstet Gynecol 2003; 22 (2):110–120.
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