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Interpeduncular angle: A new parameter for assessing intracranial hypotension in fetuses with spinal dysraphism
Author(s) -
Sepulveda Francisco,
Quezada Frank,
Montoya Francisca,
Sepulveda Waldo
Publication year - 2021
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5905
Subject(s) - medicine , fetus , cerebrospinal fluid , ventriculomegaly , magnetic resonance imaging , chiari malformation , cisterna magna , nuclear medicine , anatomy , anesthesia , radiology , pregnancy , syringomyelia , genetics , biology
Objective To investigate the role of the interpeduncular angle (IPA) as a new indicator of intracranial hypotension in fetuses with open spinal dysraphism (SD). Methods Two groups of fetuses undergoing magnetic resonance imaging (MRI) examination were identified. The study group included fetuses with open SD ( n = 21), while the control group included fetuses with a normal brain and spine ( n = 43). Two observers retrospectively evaluated axial T2‐weighted images of the brain and the IPA was identified and measured. Other features of the Chiari II malformation were also evaluated in the study group and correlated with the IPA. Results The average value (±SD) of the IPA for the study and control groups was 9.8° ± 18.5° and 60.2° ± 5.9°, respectively. The intergroup analysis of the IPA measurements revealed a statistically significant difference between the groups ( p < 0.005). Brainstem slumping or cerebellar tonsillar descent, collapse of the fourth ventricle, and ventriculomegaly also had a significant correlation with a lower IPA ( p = 0.001). Conclusion Measuring the IPA may be a useful technique for assessing the degree of intracranial hypotension in fetuses with open SD. This technique can also detect less severe cases of prenatal intracranial hypotension, even before cerebellar tonsillar descent. The lower IPA in fetuses with open SD further supports the theory that cerebrospinal fluid leakage, and not traction, is the underlying cause of Chiari II malformation.