ultrasound diagnosis of fatal anomalies

ANEURYSM OF THE VEIN OF GALEN
aging may also help. Changes in head circumference
should be monitored regularly using ultrasound.
Procedure after birth: Resection of the tumor is
possible, depending on its size and extent. Mature
teratomas are often completely resectable,
whereas immature ones can only be partly excised
and thus tend to have a high recurrence
rate.
Prognosis: This depends on the size and extent
of the tumor. In severe forms, the prognosis is
fatal.
References
Broeke ED, Verdonk GW, Roumen FJ. Prenatal ultrasound
diagnosis of an intracranial teratoma influencing
management: case report and review of the literature.
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Chan KL, Tang MH, Tse HY, et al. Factors affecting outcomes
of prenatally diagnosed tumours. Prenat
Diagn 2002; 22: 437–43.
D’Addario V, Pinto V, Meo F, Resta M. The specificity of
ultrasound in the detection of fetal intracranial
tumors. J Perinat Med 1998; 26: 480–5.
DiGiovanni LM, Sheikh Z. Prenatal diagnosis, clinical
significance and management of fetal intracranial
teratoma: a case report and literature review. Am J
Perinatol 1994; 11: 420–2.
Eckmann C, Huneke B, Schlotfeldt TC, Carstensen MH,
Reinhold S. Prenatal diagnosis of malignant intracranial
teratoma in the fetus. Geburtshilfe Frauenheilkd
1991; 51: 859–60.
Ferreira J, Eviatar L, Schneider S, Grossman R. Prenatal
diagnosis of intracranial teratoma: prolonged survival
after resection of a malignant teratoma diagnosed
prenatally by ultrasound: a case report and literature
review. Pediatr Neurosurg 1993; 19: 84–8.
Hoff NR, Mackay IM. Prenatal ultrasound diagnosis of
intracranial teratoma. JCU J Clin Ultrasound 1980; 8:
247–9.
Horton D, Pilling DW. Early antenatal ultrasound diagnosis
of fetal intracranial teratoma. Br J Radiol 1997;
70: 1299–1301.
Rodriguez-Mojica W, Goni M, Correa MS, Colon LE, Volnikh
V. Prenatal sonographic evaluation of two intracranial
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Aneurysm of the Vein of Galen
Definition: Aneurysmal dilation of the vein of
Galen may be an isolated or a multiple finding. It
results from arteriovenous malformations connecting
the arteries and the veins of the brain.
Incidence: Rare.
Sex ratio: M:F=2:1.
Clinical history/genetics: Sporadic occurrence.
Teratogens: Unknown.
Associated malformations: Heart defect, cystic
hygroma, hydrops fetalis.
Ultrasound findings: In the posterior part of the
skull, an echo-free region is observed lying in the
midline above the third ventricle. The arteries
leading to the aneurysm can be demonstrated
using the Doppler sonography. The flow within
the aneurysm can also be detected using Doppler.
This may result in widening of the intracranial
ventricles. Cardiac insufficiency may follow,
showing signs of cardiomegaly and hepatosplenomegaly.
Hydrops fetalis develops in severe
cases.
Differential diagnosis: Arachnoid cysts (differentiated
using Doppler sonography).
Clinical management: Cardiac insufficiency is
the limiting factor, and early detection of it is important.
In case of severe cardiac insufficiency
and hydrops, early delivery is indicated. The
benefit of primary cesarean section has not been
proven.
Procedure after birth: If the newborn is asymptomatic,
intervention is not needed and regular
follow-up is sufficient. In cases of hydrocephalus
or cardiac insufficiency, endovascular or even
neurosurgical interventions may be needed.
These interventions are associated with high
morbidity and mortality rates.
Prognosis: In the presence of cardiac insufficiency
and hydrops, the prognosis is very poor;
otherwise, a perioperative mortality of 20% is
expected. Survivors rarely show symptoms in
later life.
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