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Radiology
Vascular Cerebral Anomalies
Built from Obstetric Imaging
What’s inside
5 sections · 94 slides
Overview
- What this topic covers
- Why these lesions matter
- How early can a scan find them?
- Three families of cerebral vascular anomaly
- The three families in plain words
- Where the brain's blood drains away
- Reading the venous map
Aneurysm of the vein of Galen
The commonest cerebral vascular anomaly - and the one where treatment now works
- What a vein of Galen aneurysm is
- When and how it forms
- How the aneurysm builds up
- Is it inherited?
- <1%
- Reading those numbers
- Why the baby becomes ill
- Vascular steal: the brain robbed of blood
- Venous pressure and big ventricles
- Three ways the malformation causes harm
- How good is ultrasound at finding it?
- The classic ultrasound picture
- The side-on view
- Vein of Galen aneurysm on fetal ultrasound
- The racket-shaped sac in the axial view
- The elongated sac in the side-on view
- When the aneurysm clots off
- Why colour Doppler is essential
- Doppler and heart findings in vein of Galen aneurysm
- An enlarged fetal heart alongside the brain lesion
- The dilated vein seen from above after birth
- The aneurysm and its drainage seen side-on
- Magnetic resonance view of the same malformation
- What MRI adds
- What MRI cannot do
- Looking at the heart
- What else can look like this
- Treatment before birth
- Treating the fetus directly
- Treatment after birth
- What can go wrong with embolisation
Dural sinus malformation
A giant venous lake at the back of the skull that often clots - and often melts away
- What a dural sinus malformation is
- Two recognised types
- Where it comes from
- How common is it?
- Clot or malformation?
- How it is usually found
- What ultrasound shows
- The Doppler difference
- Dural sinus malformation and its resolution on fetal ultrasound
- No colour signal inside the mass
- The same lesion four weeks later
- 45%
- Other things to look for
- The good news about clots
- Signs that point to a good outcome
- What MRI shows here
- MRI can date the clot
- What else looks like this
- Treatment before birth
- Finding it before birth changes the outcome
- Outcome among survivors
- Treatment after birth
- If embolisation does not work
Pial arteriovenous fistula
A single direct artery-to-vein short circuit on the surface of the brain
- What a pial arteriovenous fistula is
- What it looks like structurally
- Where in the brain it sits
- 4%
- Reading those numbers
- Why it is rarely caught before birth
- The clue: an unexplained big heart
- Ask about the family
- How it shows up at different ages
- The same story in words
- Finding it on ultrasound
- Telling the two apart with Doppler
- Abnormal brain vessels on catheter angiography
- What MRI adds for this lesion
- What else looks like this
- Treatment before birth
- Why the vessels keep growing
- Why timing after birth is different
- How a pial fistula is treated
Putting it together
What the referring physician needs to know
- What the referring physician needs to know
- What the referring physician needs to know (continued)
- The prenatal workup, step by step
- Takeaways
- References
- References (continued)
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- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition