Related Experiment Videos
Pre-natal diagnosis of occult spinal dysraphism by ultrasonography and post-natal evaluation by MR scanning
T S Sattar1, C M Bannister, S A Russell
1Department of Neurosurgery, Booth Hall Children's Hospital, Manchester, UK.
Insights
Prenatal ultrasonography can diagnose occult spinal dysraphism in fetuses. This early detection of spinal cord abnormalities aids in assessing potential outcomes for affected newborns.
Area of Science:
- Medical Imaging
- Pediatric Neurology
- Fetal Medicine
Background:
- Occult spinal dysraphism presents diagnostic challenges compared to spina bifida aperta.
- Accurate prenatal diagnosis is crucial for informed management and prognosis.
Purpose of the Study:
- To evaluate the efficacy of prenatal ultrasonography in diagnosing various forms of occult spinal dysraphism.
- To correlate prenatal ultrasound findings with postnatal MRI in a cohort of affected infants.
Main Methods:
- Retrospective analysis of prenatal ultrasound scans in 8 fetuses diagnosed with spinal dysraphism.
- Postnatal confirmation and detailed characterization of spinal lesions using Magnetic Resonance (MR) imaging.
Main Results:
- Prenatal ultrasound identified spina bifida in all 8 fetuses, with specific findings including elongated spinal cords (5 cases) and suspected meningoceles (3 cases).
- Postnatal MRI confirmed lipomeningocele in one case initially suspected as meningocele and validated intradural lipomas in three cases.
- Vertebral anomalies, midline bony spurs, and spinal canal widening were noted in three fetuses, all with skin-covered lesions.
Conclusions:
- Prenatal ultrasonography is effective in detecting occult spinal dysraphism, including specific subtypes like lipomeningocele and intradural lipomas.
- Early prenatal identification of spinal dysraphic lesions allows for a more precise assessment of fetal prognosis.
- This capability enhances the management planning for newborns with these congenital conditions.
Abstract:
Eight children born with occult spinal dysraphism were diagnosed in utero by ultrasonography. Post-natally, they were evaluated by MR scans. The ultrasound scans in all 8 fetuses revealed a spina bifida: the spinal cord was long in 5 and in 3 a meningocele was thought to be present, however, in 1, a post-natal MR scan revealed a lipomeningocele instead of a simple meningocele. In 3 fetuses an echogenic area was seen on the ultrasound scan which raised the possibility that an intradural lipoma was present, and was confirmed by post-natal MR scans. In 3 fetuses vertebral body anomalies and an additional ossification centre in a midline bony spur together with widening of the spinal canal were seen in the lower lumbar region. The lesions in all 8 fetuses were skin-covered. None had ventriculomegaly or an Arnold-Chiari malformation. The prognosis for fetuses with spina bifida aperta is well documented in contrast to that for those with spina bifida occulta. The ability to identify a spinal dysraphic lesion pre-natally allows a more accurate assessment to be made of the likely outcome for an individual fetus.