Fetal and postnatal MRI findings of Blake pouch remnant causing obstructive hydrocephalus

Nagaraj, Usha D.; Kline‐Fath, Beth M.; Calvo-Garcia, Maria A.; Vadivelu, Sudhakar; Venkatesan, Charu

doi:10.1016/j.radcr.2020.09.039

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…Blake pouch remnant, which has been characterized by a tegmento-vermian angle of ≥18 • in the ultrasound literature, can be seen in isolation or in the presence of vermian hypoplasia [56]. Fetal MRI can help distinguish between the two entities which is important as patients with vermian hypoplasia with co-existing Blake pouch remnant are more likely to have underlying genetic conditions than those with isolated Blake pouch remnant, which tend to have good outcomes but do need close postnatal follow-up to monitor for developing obstructive hydrocephalus [57] (Figure 8).…”

Section: Dandy-walker Continuummentioning

confidence: 99%

Clinical Applications of Fetal MRI in the Brain

Nagaraj

Kline‐Fath

2022

Diagnostics

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Fetal magnetic resonance imaging (MRI) has become a widely used tool in clinical practice, providing increased accuracy in prenatal diagnoses of congenital abnormalities of the brain, allowing for more accurate prenatal counseling, optimization of perinatal management, and in some cases fetal intervention. In this article, a brief description of how fetal ultrasound (US) and fetal MRI are used in clinical practice will be followed by an overview of the most common reasons for referral for fetal MRI of the brain, including ventriculomegaly, absence of the cavum septi pellucidi (CSP) and posterior fossa anomalies.

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Section: Dandy-walker Continuummentioning

confidence: 99%

Clinical Applications of Fetal MRI in the Brain

Nagaraj

Kline‐Fath

2022

Diagnostics

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“…Prenatally diagnosed isolated BP, in which the vermis is normal in size with an elevated TVA, generally portends a good prognosis; however, close follow-up is suggested because postnatal obstructive hydrocephalus can develop. [18][19][20][21] Isolated vermian hypoplasia also can portend a good prognosis. 22 However, prenatally diagnosed classic DWM can portend a worse prognosis, with an increased incidence of chromosomal and associated structural described.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Posterior Fossa Biometric Measurements on Fetal MRI in the Evaluation of Dandy-Walker Continuum

Nagaraj

Kline‐Fath

Horn

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Dandy-Walker malformation, vermian hypoplasia, and Blake pouch remnant represent a continuum of anomalies and are common reasons for referral for fetal MR imaging. This study aimed to determine biometric measurements that quantitatively delineate these 3 posterior fossa phenotypes. MATERIALS AND METHODS:Our single-center institutional review board approved a retrospective analysis of all fetal MRIs for posterior fossa malformations, including Dandy-Walker malformation, vermian hypoplasia, and Blake pouch remnant. Measurements included the anterior-to-posterior pons, craniocaudal and anterior-to-posterior vermis, lateral ventricle size, and tegmentovermian and posterior fossa angles. Measurements were compared with normal biometry and also between each subgroup. RESULTS: Thirty-three fetuses met the criteria and were included in the study. Seven were designated as having Dandy-Walker malformation; 16, vermian hypoplasia; and 10, Blake pouch remnant. No significant group interactions with adjusted mean gestational age for tegmentovermian and posterior fossa angles were observed. The tegmentovermian angle was significantly higher in Dandy-Walker malformation (109.5°[SD, 20.2°]) compared with vermian hypoplasia (52.13°[SD, 18.8°]) and Blake pouch remnant (32.1°[SD, 17.9°]), regardless of gestational age. Lateral ventricle sizes were significantly higher in Dandy-Walker malformation at a mean of $23.1 weeks' gestational age compared with vermian hypoplasia and Blake pouch remnant. The anterior-to-posterior and craniocaudal vermes were significantly smaller in Dandy-Walker malformation compared with vermian hypoplasia and Blake pouch remnant at mean of $23.1 weeks' gestational age.

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“…Complications including hydrocephalus requiring shunt placement were noted in our study and have been reported in the literature. 8,14 Counseling should emphasize close follow-up with monitoring of head circumference postnatally.…”

Section: Discussionmentioning

confidence: 99%

Short- and Long-Term Outcomes of Prenatally Diagnosed Dandy-Walker Malformation, Vermian Hypoplasia, and Blake Pouch Cyst

et al. 2021

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Dandy-Walker continuum, which includes Dandy-Walker malformation, vermian hypoplasia, and Blake pouch cyst, is among the most commonly diagnosed posterior fossa malformation by fetal magnetic resonance imaging (MRI). The objective of our retrospective study was to evaluate fetal and postnatal MRI scan and clinical outcomes. Seventy-two patients were identified; 40 patients had postnatal imaging and follow-up (7 Dandy-Walker malformation, 26 vermian hypoplasia, and 7 Blake pouch cyst). Although all patients with Dandy-Walker malformation required ventriculoperitoneal shunts and 66% were intubated at birth, none required tracheostomy tube and 2 of 5 surviving children had no neurologic deficits. Vermian hypoplasia was strongly associated with genetic conditions and cardiac malformations; odds of not ambulating normally were 12 times greater if a syndrome or injury was present. Echocardiogram and genetic screening are recommended with vermian hypoplasia. There is a risk for epilepsy in both Dandy-Walker malformation and vermian hypoplasia. Blake pouch cyst can be complicated by hydrocephalus, but outcome is favorable.

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Fetal and postnatal MRI findings of Blake pouch remnant causing obstructive hydrocephalus

Cited by 7 publications

References 8 publications

Clinical Applications of Fetal MRI in the Brain

Clinical Applications of Fetal MRI in the Brain

Evaluation of Posterior Fossa Biometric Measurements on Fetal MRI in the Evaluation of Dandy-Walker Continuum

Short- and Long-Term Outcomes of Prenatally Diagnosed Dandy-Walker Malformation, Vermian Hypoplasia, and Blake Pouch Cyst

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