Cranial findings detected by second-trimester ultrasound in fetuses with myelomeningocele: a systematic review

TY - JOUR

T1 - Cranial findings detected by second-trimester ultrasound in fetuses with myelomeningocele

T2 - a systematic review

AU - Kunpalin, Y.

AU - Richter, J.

AU - Mufti, N.

AU - Bosteels, J.

AU - Ourselin, S.

AU - De Coppi, P.

AU - Thompson, D.

AU - David, A. L.

AU - Deprest, J.

N1 - Funding Information: This research was funded by an Innovative Engineering for Health award by the Wellcome Trust (WT101957) and an Engineering and Physical Sciences Research Council (EPSRC) grant (NS/A000027/1). JD is supported by the Great Ormond Street Hospital for Children's Charity. JB is supported by the Department of Development and Regeneration, Cluster Woman and Child. ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. PC is supported by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. Funding Information: This research was funded by an Innovative Engineering for Health award by the Wellcome Trust (WT101957) and an Engineering and Physical Sciences Research Council (EPSRC) grant (NS/A000027/1). JD is supported by the Great Ormond Street Hospital for Children's Charity. JB is supported by the Department of Development and Regeneration, Cluster Woman and Child. ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. PC is supported by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. We thank Raigam J. Martinez-Portilla and Veronica Parisi for their contribution of statistics and search engine advice. Funding Information: This systematic review is reported according to the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA) guidelines ( www.prisma‐statement.org ). We have published our protocol prospectively in the Prospero registry (CRD42019139703). This research is funded by an Innovative Engineering for Health award from the Wellcome Trust (WT101957) and an Engineering and Physical Sciences Research Council (EPSRC) grant (NS/A000027/1). There was no patient and public involvement in this review. 14 Publisher Copyright: © 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/1

Y1 - 2021/1

N2 - Background: Abnormal intracranial findings are often detected at mid-trimester ultrasound (US) in fetuses with myelomeningocele (MMC). It is unclear whether these findings constitute a spectrum of the disease or are an independent finding, which should contraindicate fetal surgery. Objective: To ascertain the spectrum and frequency of US-detected cranial findings in fetuses with MMC. Search strategy: MEDLINE, Embase, Web of Science and CENTRAL were searched from January 2000 to June 2020. Selection criteria: Study reporting incidence of cranial US findings in consecutive cases of second-trimester fetuses with MMC. Data collection and analysis: Publication quality was assessed by Newcastle–Ottawa Scale (NOS) and modified NOS. Meta-analysis could not be performed as a result of high clinical diversity and study heterogeneity. Main results: Fourteen cranial US findings were reported in 15 studies. Findings in classic Chiari II malformation (CIIM) spectrum included posterior fossa funnelling (96%), small transcerebellar diameter (82–96%), ‘banana’ sign (50–100%), beaked tectum (65%) and ‘lemon’ sign (53–100%). Additional cranial findings were small biparietal diameter (BPD) and head circumference (HC) (<5th centile; 53 and 71%, respectively), ventriculomegaly (45–89%), abnormal pointed shape of the occipital horn (77–78%), thinning of the posterior cerebrum, perinodular heterotopia (11%), abnormal gyration (3%), corpus callosum disorders (60%) and midline interhemispheric cyst (42%). Conclusions: We identified 14 cranial findings by second-trimester US in fetuses with MMC. The relatively high incidence of these findings and their unclear prognostic significance might not contraindicate fetal surgery in the case of normal fetal genetic testing. Some cranial findings may independently affect postnatal outcome, however. Long-term detailed follow-up is required to investigate this. Tweetable abstract: A high rate of cranial abnormalities found on second-trimester ultrasound in fetuses with myelomeningocele.

AB - Background: Abnormal intracranial findings are often detected at mid-trimester ultrasound (US) in fetuses with myelomeningocele (MMC). It is unclear whether these findings constitute a spectrum of the disease or are an independent finding, which should contraindicate fetal surgery. Objective: To ascertain the spectrum and frequency of US-detected cranial findings in fetuses with MMC. Search strategy: MEDLINE, Embase, Web of Science and CENTRAL were searched from January 2000 to June 2020. Selection criteria: Study reporting incidence of cranial US findings in consecutive cases of second-trimester fetuses with MMC. Data collection and analysis: Publication quality was assessed by Newcastle–Ottawa Scale (NOS) and modified NOS. Meta-analysis could not be performed as a result of high clinical diversity and study heterogeneity. Main results: Fourteen cranial US findings were reported in 15 studies. Findings in classic Chiari II malformation (CIIM) spectrum included posterior fossa funnelling (96%), small transcerebellar diameter (82–96%), ‘banana’ sign (50–100%), beaked tectum (65%) and ‘lemon’ sign (53–100%). Additional cranial findings were small biparietal diameter (BPD) and head circumference (HC) (<5th centile; 53 and 71%, respectively), ventriculomegaly (45–89%), abnormal pointed shape of the occipital horn (77–78%), thinning of the posterior cerebrum, perinodular heterotopia (11%), abnormal gyration (3%), corpus callosum disorders (60%) and midline interhemispheric cyst (42%). Conclusions: We identified 14 cranial findings by second-trimester US in fetuses with MMC. The relatively high incidence of these findings and their unclear prognostic significance might not contraindicate fetal surgery in the case of normal fetal genetic testing. Some cranial findings may independently affect postnatal outcome, however. Long-term detailed follow-up is required to investigate this. Tweetable abstract: A high rate of cranial abnormalities found on second-trimester ultrasound in fetuses with myelomeningocele.

KW - Chiari II malformation

KW - fetal surgery

KW - myelomeningocele

KW - prenatal

KW - spina bifida

KW - spina bifida aperta

KW - spinal dysraphism

KW - ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=85098564936&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.16496

DO - 10.1111/1471-0528.16496

M3 - Review article

C2 - 32926566

AN - SCOPUS:85098564936

SN - 1470-0328

VL - 128

SP - 366

EP - 374

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - 2

ER -