Fetomaternal III (CNS and Fetal Brain Anomaly)

CNS AND FETAL BRAIN ANOMALIES
CNS AND
FETALBRAIN
ANOMALIES
PR E SE NTE D BY
dr.Yuri Kamila, SpOG, SubspKFM, MSc.Us,
MARS
RSUD Siti Fatimah Az-Zahra
Palembang
1 BACKGROUND
2 FETAL NEURODEVELOPMENT
3 NEUROSONOGRAPHIC FETAL CNS
OUTLINE 4 FETAL CNS ANOMALIES (TM I)

5 FETAL CNS ANOMALIES (TM 2 &3)
6 TAKE HOME MESSAGE
7 REFERENCES
BACKGROUND
• Central nervous system(CNS) malformations are someof
the most common congenital abnormalities, with an
incidence at birth of 14/10.000
• CNS malformations are second only to cardiac
malformations in terms of frequency of occurrence.
• Neural tube defects: the most frequent (prevalence of
52/100.000)
• In the first, second, and third trimester of pregnancy it is
possible to identify fetal brain malformations by ultrasound.
Backto Agenda
FETAL
NEURODEVE
- LOPMENT
Backto Agenda
FETAL NEURODEVELOPMENT
Backto Agenda
Backto Agenda
-Pooh RK, Matsuzawa N et al. Neurosonographic Approach to Malformations of Cortical Development; Review article
DSJUOG Vol 15, Isssue 2, 2021
-Kadic AS, Predojevic M, Kurjak A. Advances in Fetal Neurophysiology; DSJUOG 2008
Backto Agenda
Kadic AS, Predojevic M, Kurjak A. Advances in Fetal Neurophysiology; DSJUOG 2008

Kurjak A, Antsaklis P et al. Multicentric studies of the fetal neurobehavior by KANET test.J . Perinat Med.2017:45(6)
Backto Agenda
KURJAK ANTENATAL
NEURODEVELOPMENTAL TEST (KANET)
Backto Agenda
KURJAK ANTENATAL
NEURODEVELOPMENTAL TEST (KANET)
Backto Agenda
NEUROSONO
- GRAPHY
OF FETAL CNS
Backto Agenda
First Trimester Ultrasound
-ISUOG Practice Guidelines: performance of first-trimester fetal ultrasound scan, Ultrasound Obstet Gynecol 2013
-Ungureanu DR, Dragusin RC et alFirst Trimester Ultrasound Detection of Fetal Central Nervous System Anomalies; Brain Sci 2023
Backto Agenda
First Trimester Ultrasound
Nuchal Transluchency Fetal spine
Backto Agenda
INTRACRANIAL TRANSLUCHENCY
Intracranial Transluchency (4th Ventricle)
Backto Agenda
NEUROSONOGRAPHY FETAL BRAIN
Second and third trimester
Four standard viewsare used for assessment

of the elements of the fetal head:
• 1 = falx view,
• 2 = transventricular view,
• 3 = cavum view,
• 4 = posterior fossa or transcerebellar view
Backto Agenda

Cavum view
Falx view
Transcerebellar view
Transventricular view
Backto Agenda

A systematicevaluation of the brain usually includes visualization of
four coronal and three sagittal planes (ISUOG, 2021)
Coronal planes
(a)Transfrontal plane.
(b) Transcaudate plane.
(c) Transthalamic plane.
(d) Transcerebellar plane.
Backto Agenda

Sagittal planes of fetal head.
(a)Midsagittal anterior plane: median section of

corpus callosum (arrows); below it, cavumsepti
pellucidi with cavumvergae (whenpresent); third
ventricle (3); fourth ventricle (*); cerebellar vermis
(V). Sylvian aqueduct mayalso be visualized.
(b)Parasagittal plane: brain parenchyma (BP); lateral

ventricle (lv) with its choroid plexus (cp); temporal
horn; small part of Sylvian fissure (arrow).
ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted
neurosonography. Ultrasound Obstet Gynecol 2021; 57: 661–671
Backto Agenda
Backto Agenda
Transventricular (a) and transcerebellar (b) planes of fetal brain at 16 weeks.
Backto Agenda
Backto Agenda
NEUROSONOGRAPHY FETAL SPINE

• Transverse or axial planes.
• Sagittal planes.
• Coronal planes.
Sagittal view of lower thoracic and sacral

fetal spine at 18 gestational weeks.
Backto Agenda

• Coronal planes.
Coronal view of fetal spine
Backto Agenda

• Coronal planes.
Axial views of fetal spine at different

levels: (a) cervical; (b) thoracic; (c)
lumbar; (d) sacral
Backto Agenda
MRIof Fetal Brain
Considered May add significant

complementary to clinical information
neurosonography when requested
Performed only after, and to

Can replace
complement a neurosonographic
neurosonography as the
examination and only if indicated by
second-line evaluation
an expert
Backto Agenda
FETAL CNS
ANOMALIE
S INFIRST
TRIMESTER
Backto Agenda
ACRANIA/EXENCEPHALY/ANENCEPHALY
Normal sagittal scanof fetus at first TM Sagittal scanof afetus at 11 weeks’ gestation
with cerebral tissue but there is no skull
Backto Agenda
Normal sagittal scanof fetus at first TM Sagittal scanof afetus at 13 weeks,

revealing asmall massabove theorbits
Backto Agenda
Normal Normal
Backto Agenda
OPENSPINABIFIDA
NORMAL
a) cervical; (b) thoracic; (c) lumbar; (d) sacral
Backto Agenda
ENCEPHALOCELE
Normal fetal brain US at 11weeks
Backto Agenda
MECKEL GRUBER SYNDROME
Backto Agenda
HYDROCEPHALUS: VENTRICULOMEGALY
Hydrocephaly at 12 weeks. Axial scanswith enlarged lateral ventricles at two
different levels (A and B) and the choroid plexus occupying only apart of ventricles
NORMAL Transverse axial scan at the level of lateral ventricles. (1) Lateral ventricles (2) Choroid
plexus (3) Cavum septum pellucidum. b Coronal view of fetal lateral ventricles through, posterior
fontanel, CP choroid plexus, FH frontal horns
Backto Agenda
HOLOPROSENCEPHALY
Alobar HPE: one

ventricle and fused
thalami
Normal first trimester anatomy of the fetalbrain

abstracthttps://www.dsjuog.com/abstractArticleContentBrowse/DSJUOG/5933/JPJ/fullText
Backto Agenda
HOLOPROSENCEPHALY
Backto Agenda
HOLOPROSENCEPHALY
Backto Agenda
SACROCOCCYGEAL TERATOMA
NORMAL
Backto Agenda
FETAL CNS
ANOMALIES
IN2ND&3RD
TRIMESTER
Backto Agenda
NORMAL
Backto Agenda
NORMAL
Backto Agenda
ARACHNOID CYST
NORMAL
Backto Agenda
BLAKE'S POUCH CYST
NORMAL
Backto Agenda
BRAIN TERATOMA
Backto Agenda
CEREBELLAR DYSPLASIAS
NORMAL
Backto Agenda
CHOROID PLEXUS CYSTS
NORMAL
CHOROID PLEXUS CYSTS
Butterfly
sign CPC: Choroid Plexus Cyst
CORPUS CALLOSUM AGENESIS
Backto Agenda
DANDY-WALKER MALFORMATION
NORMAL
Backto Agenda
DURALSINUSTHROMBOSIS
Backto Agenda
HYDRANENCEPHALY
NORMAL
Backto Agenda
HEMIMEGALENCEPHALY
NORMAL
Backto Agenda
LISSENCEPHALY
Pooh RK, Matsuzawa N et al. Neurosonographic Approach to Malformations of Cortical Development; DSJUOG Volume 15, issue 2, 2021
Backto Agenda
SCHIZENCEPHALY
Open-lip schizencephaly
Backto Agenda
MIGRATION DISORDER
Backto Agenda
MEGACISTERNA MAGNA
NORMAL
Backto Agenda
MACROCEPHALY
Backto Agenda
MICROCEPHALY
NORMAL
Microcephaly pada usia 18

minggu
Backto Agenda
PORENCEPHALIC CYST
NORMAL
Backto Agenda
HEMIVERTEBRA
NORMAL
Backto Agenda
HEMIVERTEBRA
Backto Agenda
TUBEROUS SCLEROSIS
Backto Agenda
SEPTO-OPTIC DYSPLASIA
NORMAL
Backto Agenda
VEINOF GALEN ANEURYSM
Backto Agenda
TAKEHOMEMESSAGE
• Fetal CNS abnormalities are a leading cause of in utero mortality
and postnatal morbidity, and accurate prenatal diagnosis with
US is essential for appropriate management
• Some malformations may be detectable as early as the first-

trimester scan
• If suspicion of a brain or spinal abnormality is raised during the

obstetric ultrasound screening examination, the woman should
undergo targeted fetal neurosonography as a diagnostic
examination
Backto Agenda
THAN
K YOU
REFERENCES
• Cater SW, Boyd BK, Ghate S V. Abnormalities of the fetal central nervous system: Prenatal us diagnosis with postnatal
correlation. Radiographics. 2020;40(5):1458-1472.
• Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: Performance of first-trimester fetal ultrasound
scan. Ultrasound in Obstetrics and Gynecology. 2013;41(1):102-113.
• Fong KW, Ghai S, Toi A, Blaser S, Winsor EJT, Chitayat D. Prenatal ultrasound findings of lissencephaly associated with
Miller-Dieker syndrome and comparison with pre- and postnatal magnetic resonance imaging. Ultrasound in Obstetrics
and Gynecology. 2004;24(7):716-723.
• Paladini D, Malinger G, Birnbaum R, et al. ISUOG Practice Guidelines (updated): sonographic examination of the fetal
central nervous system. Part 2: performance of targeted neurosonography. Ultrasound in Obstetrics and Gynecology.
2021;57(4):661-671.
• Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated):
sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and
indications for targeted neurosonography. Ultrasound in Obstetrics and Gynecology. 2020;56(3):476-484.
Backto Agenda
REFERENCES
• Van den Veyver, IB. Prenatally diagnosed developmental abnormalities of the central nervous system and genetic syndromes: A
practical review. Prenatal Diagnosis. 2019; 39: 666–678.
• Moreira Neto R, Porovic S. Clinical study of fetal neurobehavior by the KANET test. J Perinat Med. 2018;46(6):631-639.
• Ungureanu DR, Drăgușin RC, Căpitănescu RG, Zorilă L, Ofițeru AMI, Marinaș C, Pătru CL, Comănescu AC, Comănescu MC, Sîrbu OC,
et al. First Trimester Ultrasound Detection of Fetal Central Nervous System Anomalies. Brain Sciences. 2023; 13(1):118.
• Krutzke SK, Engels H, Hofmann A, et al. Array-based molecular karyotyping in fetal brain malformations: Identification of novel
candidate genes and chromosomal regions. Birth Defects Res A Clin Mol Teratol. 2016;106(1):16-26.
• Wyldes M, Watkinson M. Isolated mild fetal ventriculomegaly. Arch Dis Child Fetal Neonatal Ed. 2004;89(1).
• Monteagudo A. Exencephaly-anencephaly Sequence. Am J Obstet Gynecol. 2020;223(6):B5-B8.
• Pooh RK. Fetal Neuroimaging of Neural Migration Disorder. Ultrasound Clin. 2008;3(4):541-552.
Backto Agenda

Fetomaternal III (CNS and Fetal Brain Anomaly)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Fetomaternal III (CNS and Fetal Brain Anomaly)

Uploaded by

Copyright:

Available Formats

CNS AND FETAL BRAIN ANOMALIES

3 NEUROSONOGRAPHIC FETAL CNS

OUTLINE 4 FETAL CNS ANOMALIES (TM I)

CNS AND FETAL BRAIN ANOMALIES

6 TAKE HOME MESSAGE

Kadic AS, Predojevic M, Kurjak A. Advances in Fetal Neurophysiology; DSJUOG 2008

First Trimester Ultrasound

First Trimester Ultrasound

Nuchal Transluchency Fetal spine

Intracranial Transluchency (4th Ventricle)

NEUROSONOGRAPHY FETAL BRAIN

Second and third trimester

Four standard viewsare used for assessment

NEUROSONOGRAPHY FETAL BRAIN

NEUROSONOGRAPHY FETAL BRAIN

NEUROSONOGRAPHY FETAL BRAIN

(a)Midsagittal anterior plane: median section of

(b)Parasagittal plane: brain parenchyma (BP); lateral

NEUROSONOGRAPHY FETAL BRAIN

NEUROSONOGRAPHY FETAL BRAIN

Transventricular (a) and transcerebellar (b) planes of fetal brain at 16 weeks.

NEUROSONOGRAPHY FETAL BRAIN

NEUROSONOGRAPHY FETAL SPINE

Sagittal view of lower thoracic and sacral

NEUROSONOGRAPHY FETAL SPINE

Coronal view of fetal spine

NEUROSONOGRAPHY FETAL SPINE

Axial views of fetal spine at different

MRIof Fetal Brain

Considered May add significant

Performed only after, and to

Normal sagittal scanof fetus at first TM Sagittal scanof afetus at 13 weeks,

a) cervical; (b) thoracic; (c) lumbar; (d) sacral

Alobar HPE: one

Normal first trimester anatomy of the fetalbrain

BLAKE'S POUCH CYST

CHOROID PLEXUS CYSTS

CHOROID PLEXUS CYSTS

CORPUS CALLOSUM AGENESIS

Microcephaly pada usia 18

VEINOF GALEN ANEURYSM

• Some malformations may be detectable as early as the first-

• If suspicion of a brain or spinal abnormality is raised during the

• Monteagudo A. Exencephaly-anencephaly Sequence. Am J Obstet Gynecol. 2020;223(6):B5-B8.

You might also like