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Tectal plate dysmorphism in atretic cephaloceles: an underrecognized but frequent imaging feature
Seda Kaynak Sahap1, Beyza Nur Atalan2, Suat Fitoz1
1Department of Pediatric Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey.
Insights
Tectal plate dysmorphism, a common finding in atretic cephalocele patients, is often overlooked. This imaging feature may indicate shared developmental origins with other midline abnormalities.
Area of Science:
- Neuroimaging
- Pediatric Radiology
- Developmental Biology
Background:
- Atretic cephalocele is a posterior fossa malformation.
- Tectal plate morphology is crucial for understanding brain development.
Purpose of the Study:
- To systematically evaluate tectal plate morphology in patients with atretic cephaloceles.
- To determine if tectal dysmorphism is an underrecognized imaging feature.
Main Methods:
- Retrospective review of MRI scans from 13 pediatric patients with atretic cephaloceles.
- Assessment of tectal plate contour, thickness, and beaking.
- Evaluation of associated venous anomalies, fibrous stalk, CSF cleft, tentorial abnormalities, and midline/posterior fossa anomalies.
Main Results:
- Tectal plate dysmorphism was present in 61.5% of patients, with beaking in 75% of those cases.
- Persistent falcine sinus (61.5%) and tentorial peaking (100%) were common.
- Enlarged superior cerebellar cistern (92.3%) and other midline/posterior fossa anomalies were noted.
Conclusions:
- Tectal dysmorphism is a frequent, underrecognized feature of atretic cephalocele.
- Association with venous anomalies suggests a shared developmental pathway.
- This finding may offer additional diagnostic value in pediatric neuroimaging.
Objective:
To systematically evaluate tectal plate morphology in patients with atretic cephaloceles and to determine whether tectal dysmorphism represents an underrecognized imaging feature.
Methods:
In this retrospective study, MRI examinations of 13 pediatric patients with parietal and/or occipital atretic cephaloceles were reviewed. Tectal morphology was assessed on sagittal 3D T1-weighted images for contour, thickness, and the presence of tectal beaking, and the extent of dysmorphic involvement, either the entire tectal plate or selective involvement of the inferior colliculus, was recorded. Associated imaging findings, including venous anomalies, fibrous stalk, CSF cleft, tentorial abnormalities, and additional midline and posterior fossa anomalies, were also evaluated. Descriptive statistics were used for data analysis.
Results:
Tectal plate dysmorphism was identified in 8 of 13 patients (61.5%), and 6 of these (75%) demonstrated a tectal beaking configuration. The pattern of involvement included both the entire tectal plate and selective involvement of the inferior colliculus. Persistent falcine sinus was observed in 8 patients (61.5%), occurring in all parietal lesions but in only one isolated occipital lesion. Additional imaging findings included tentorial peaking, observed in all patients (100%), and enlargement of the superior cerebellar cistern in 12 patients (92.3%), along with various midline and posterior fossa anomalies.
Conclusion:
Tectal dysmorphism is a relatively frequent and underrecognized imaging feature of atretic cephalocele. Its association with venous anomalies and dorsal midline abnormalities suggests a shared developmental background and may provide additional diagnostic value.
