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Published on: February 29, 2020
Malformations of the fetal dural sinuses
Matthew McInnes1, Katherine Fong, Andrea Grin
1Department of Medical Imaging, The Ottawa Hospital-General Campus, Ottawa, Canada.
Summary
Congenital dural sinus malformations (DSM) can present antenatally with sinus dilation and thrombosis. Early fetal imaging may miss associated arteriovenous malformations, highlighting the need for further study.
Area of Science:
- Fetal vascular malformations
- Congenital neurovascular anomalies
- Pediatric radiology and pathology
Background:
- Dural sinus malformation (DSM) involves congenital dilation of dural sinuses, often with arteriovenous shunts.
- Early natural history and anatomy of fetal DSM are not well-defined.
- DSM can be detected antenatally.
Observation:
- A review of fetal autopsies identified three cases of primary dural sinus malformations.
- Fetal ultrasound and MRI at 19-23 weeks showed dural sinus dilation in all cases.
- Thrombosis was observed in dural sinuses or arteriovenous fistulas in two cases.
Findings:
- Post-mortem correlation revealed complex vascular anomalies, including remodeling and pial arteriovenous fistulas.
- Initial imaging missed arteriovenous malformations in two of the three cases, which were only evident at autopsy.
- One case presented with features overlapping the vein of Galen aneurysmal malformation.
Implications:
- In utero thrombosis is a significant feature of fetal dural sinus malformations.
- Current imaging may not fully capture the extent of fetal DSM and associated arteriovenous malformations.
- Further research is needed to understand the early developmental trajectory of dural sinus malformations.
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