Ultrasound characteristics of fetal brain structures in Arnold-Chiari malformation type II


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Abstract

Objective: To evaluate the echographic characteristics of brain structures in fetuses with Arnold-Chiari type II malformation. Materials and methods: We analyzed 25 cases of pregnancy with Arnold- Chiari type II malformations diagnosed between 12 and 21 weeks. All patients received clinical consultation at the V.I. Kulakov NMRC for OG&P from January 2019 to February 2022. Fetal evaluation included expert anatomical examination, extended two-dimensional echocardiography, and detailed evaluation of CNS structures. At 23.1-25.5 weeks’ gestation, 20 fetuses underwent successful intrauterine fetal surgery for Spina Bifida. In the remaining 5 cases, the pregnancy was terminated at the place of residence. Results: At 12-14 weeks of gestation, all 5 fetuses had an abnormal amount of cerebrospinal fluid in the lateral ventricles, stenotic or not visible by ultrasound cerebral aqueduct with displacement of its posterior contour toward the occipital bone, and a «banana»-shaped cerebellum. At 19-21 weeks’ gestation, additional cerebral signs were identified, including corpus callosum abnormalities, dorsal cystic enlargement of ventricle III, interhemispheric holoprosencephaly, beak-like appearance of the tectum, sharpened occipital horns of the lateral ventricles, and delayed sulcation. Conclusion: Alterations in supraand infratentorial brain structures are characteristic of Arnold- Chiari malformation type II. Early echographic detection of cerebral signs of Arnold-Chiari type II allows timely decision making on fetal intrauterine surgery for Spina Bifida in the case of prolonged pregnancy.

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About the authors

Liliyana A. Chugunova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: lchugunova@oparina4.ru
PhD, Senior Researcher, Department of Ultrasound and Functional Diagnosis

Roman G. Shmakov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: r_shmakov@oparina4.ru
Dr. Med. Sci, Professor of the Russian Academy of Sciences, Director of the Institute of Obstetrics

Kristina A. Gladkova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: k_gladkova@oparina4.ru
PhD, Head of the 1st Obstetric Department of Pregnancy Pathology, Senior Researcher at the Fetal Medicine Unit, Institute of Obstetrics

Kirill V. Kostyukov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: k_kostyukov@oparina4.ru
Dr. Med. Sci., Head of the Department of the Ultrasound and Functional Diagnosis

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