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Spontaneous regression of fetal dural sinus malformation
Sneha Yarlagadda1, Rajeswaran Rangasami2, Indrani Suresh3
1 Department of Radiology, Saveetha Medical College, Saveetha University, Chennai, Tamil Nadu, India
2 Department of Radiology, Sri Ramachandra University, Chennai, Tamil Nadu, India
3 Mediscan Systems, Chennai, Tamil Nadu, India
|Date of Submission||01-Dec-2021|
|Date of Decision||30-Jan-2022|
|Date of Acceptance||12-Mar-2022|
|Date of Web Publication||30-Jan-2023|
Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116, Tamil Nadu, India.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Fetal dural sinus malformation is a rare, congenital cerebrovascular malformation which requires proper diagnosis and follow-up. Here, we report a case of dural sinus malformation with partial thrombosis diagnosed in the second trimester by sonography and fetal magnetic resonance imaging, with subsequent spontaneous regression.
Keywords: Dural sinus hematoma, dural sinus thrombosis, fetal MRI
A 38-year-old pregnant woman at gestational age of 22 weeks was referred to our institution for magnetic resonance imaging (MRI) of the fetus. The routine antenatal sonography of the fetus showed a triangular hypoechoic lesion in the region of right transverse sinus Figure 1A] measuring 1.7 × 2.7 × 2.5 cm. There was no detectable vascular flow within or around the lesion on Doppler examination [Figure 1B]. Based on these sonographic findings, a diagnosis of dural sinus malformation was suspected. Fetal MRI was performed using 1.5 T system (Signa HDxT;) GE Healthcare (Milwaukee, WI, USA) for detailed evaluation. The fetal brain MRI examination using half-Fourier acquisition single-shot turbo spin-echo sequence confirmed the dural location of the lesion. It revealed dilatation of the posterior end of superior sagittal sinus, torcula, and right transverse sinuses with partial thrombosis [Figure 2A]–C]. There were no other associated anomalies. Thus, a radiological diagnosis of dural sinus malformation with partial thrombosis was made and the fetus was followed up with serial ultrasound examinations [Figure 1C]. The patient delivered at term, which was uneventful, and the baby was neurologically stable. Follow-up MRI of the neonate at day 5 of life demonstrated regression of the lesion and thrombosed component with normal flow void in the sinuses [Figure 2D–F]. The underlying brain also appeared normal.
|Figure 1: A—Sonographic transverse image of the fetal brain shows a hypoechoic lesion (arrows) in the region of torcula–right transverse sinus. B—Color Doppler imaging shows no vascular flow within the lesion (arrows). C—Follow-up scan at 27 weeks shows reduction in the size of the lesion (arrow)|
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|Figure 2: A—Axial T2, B—sagittal T2, C—coronal T2-weighted magnetic resonance images of fetus show dilated torcula, posterior end of superior sagittal sinus, and right transverse sinus (arrow). D—Axial T2, E—sagittal T2, and F—coronal T2 fluid-attenuated inversion recovery images of neonate show regression of the malformation (open arrow) and normal flow|
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Fetal dural sinus malformation is a rare entity. It is a type of congenital arteriovenous shunt according to Lasjaunias classification and is subclassified as infantile and adult types. Depending on the location, the midline type comprises giant lakes confined to posterior sinuses (torcular Herophili], posterior part of superior sagittal sinus, and transverse sinuses), whereas the lateral type involves the jugular bulb. Regarding the etiology, one theory suggests that it arises due to persistent ballooning of the sinuses between 4th and 6th months of development, causing venous hypertension and development of fistula. Another theory states that it occurs due to excessive and disorganized development of the sinuses. Previous studies showed favorable outcomes with regression of the lesion in 50–70% of fetuses. However, the complications described are thrombosis within the dural sinus malformation (DSM), ventriculomegaly, parenchymal injury due to venous ischemia, and hemorrhage., It is important to differentiate DSM from other pathologies like vein of Galen malformation, hematoma, arachnoid cyst, and intracranial mass.
Antenatally, although ultrasound is the primary modality, MRI is recommended to know the exact size and location of the lesion in relation to dural sinuses, stage of thrombus, parenchymal complications, and associated anomalies. Follow-up ultrasound at serial intervals is mandatory to look for the change in size, configuration of the lesion, and parenchymal complications, and to plan further management.
| Financial support and sponsorship|| |
| Conflicts of interest|| |
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2]