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Understanding the Corpus Callosum and Its Abnormalities - A Lecture Series by Dr. Punam Tara and Dr. Gaurika Sahi

Tonight's focus is on the decoding of the corpus callosum and its abnormalities.:

• The corpus callosum is a main commissural pathway connecting the two hemispheres.
• Dr. Punam Tara, a maternal fetal medicine specialist, will guide us through the various normal and abnormal features of the corpus callosum.

Discussing clinical application of anatomy in imaging of corpus callosum:

• Explaining the development of corpus callosum in fetal autopsy
• Highlighting the anatomical compactness and importance of corpus callosum in brain hemispheres connection

Understanding the anatomy of the corpus callosum:

• Posterior closure occurs in 97% of cases, with exceptions
• Visualizing the shape and placement of the corpus callosum is crucial

Neurosonogram S-Work Guidelines:

• Ultrasound shows anterior structures like corpus callosum and anterior commissure
• Differentiates normal and abnormal features like the thalamus and septum pellucidum

Corpus callosum is the largest commissure and unique to placental mammals:

• The corpus callosum is concerned with learning, cognitive judgment, memory, attention span, and more
• Embryogenesis of the corpus callosum completes by 20 weeks, with the best imaging approach being mid-sagittal section

Optimal transducer placement for imaging the corpus callosum:

• Use trans vaginal transducers to achieve better imaging quality
• Depending on the approach, different parts of the corpus callosum can be visualized

Understanding the corpus callosum anatomy is crucial for medical practitioners.:

• The corpus callosum is a harmonious contour and a curvilinear structure with hypoechoic and hyper echoic margins, with no kinks or angles.
• It overhangs the tectal plate and is an important reference point for measuring length and thickness using various imaging techniques.

Importance of 20 weeks timeline in ultrasound:

• Color doppler is better for pickup than grayscale before 20 weeks
• Displays the development of corpus callosum in the fetus

Discussion on the structure of the brain lobes and ventricles:

• The relationship between the anterior horns and the midline
• The implications of the teardrop shape of the lateral ventricle

Coronal section findings related to the brain's structure.:

• The absence of the km septum pellucidum and an uninterrupted inter hemispheric fissure.
• Configuration of the anterior horns, third ventricle, and the roof of the third ventricle discussed in detail.

Hemispheric cyst in the third ventricle:

• Hypertensive third ventricle pushes its roof up and extends into the interventricular fissure
• Transvaginal picture shows no corpus callosum and the cyst sitting in the midline

Lipoma appearance in the brain:

• Lipoma visible in midline as small hyperechoic blob
• Lipoma propagated through choroidal fissure into lateral ventricles

Possible Mobik Wilson syndrome with IUGR:

• Isthmus is narrow, possibility of aorta cooperation
• Microphallus observed in genitalia, consider IUGR

Abnormalities in corpus callosum can be detected from the length and width of the csp.:

• A shortened csp indicates a shortened corpus callosum, whereas a longer and narrower csp can also indicate abnormalities.
• Dr. Rabbit Chauvinitol proposed using the ratio of csp length to width to objectively assess abnormalities.

Trans vaginal sonogram provides detailed pictures of the fetus:

• Trans vaginal sonogram shows significant details of the fetal brain anatomy and corpus callosum
• Compared to other imaging techniques, trans vaginal sonogram provides superior clarity and diagnostic capability

Several case studies related to brain abnormalities and infections:

• Identification of thin corpus callosum and periventricular halo indicating fetal infection
• Coronal and parasagittal sections showing abnormalities in the cisterna magna and cerebellar hypoplasia

Wait till 20 weeks for assessment:

• Do not be over-enthusiastic in diagnosing prenatal abnormalities
• Fetal MRI is a useful adjunct, but counseling is tough

Panel discussion on the corpus callosum:

• Gaurika, a radiologist from Lafaye, leads the discussion
• The corpus callosum is referenced in ancient literature and has neurological significance

Biometry of corpus callosum for deciding its characteristics:

• Studies and articles available online since 1993
• Recent advancements in measuring length, thickness, and width

Dr. Alok's examination and findings during the 12-week and 23-week scans.:

• At 12 weeks, no abnormalities were found, and the double marker test was normal. Patient reassured.
• At 23 weeks, dilated lateral ventricles were observed, potentially missed if the patient had not come back.

Abnormalities in the brain structure and appearance.:

• The frontal horns are widely separated and have a spear horn appearance.
• The intra hemispheric fissure appears wide and runs across the brain.

Detailed evaluation for neural sonogram and possible additional abnormalities:

• Detailed neural sonogram can reveal CNS defects and other abnormalities in the brain
• Further evaluation of eyes, heart, kidneys, limbs, and other body parts is important for syndromic or genetic association

Look for associated anomalies and offer genetic testing for prognosis:

• MRI at time of diagnosis for confirmation
• 20% of cases can be false diagnosis

Abnormalities observed in 26-week findings:

• CSP appearing abnormal, suggesting significant abnormality
• Corpus callosum appears short and underdeveloped, not overhanging midbrain

Discussing brain abnormalities and genetic causes:

• Exploring non-genetic and genetic causes of abnormalities
• Considering family history and chromosomal translocation

Corpus Callosum Abnormalities:

• About 10 to 15 percent of cases exhibit abnormalities of number or structure
• Chromosomal abnormalities of number are chromosome 13 and 18

Challenges in decision-making during pregnancy:

• Tests and gestation are critical in deciding whether to continue or discontinue pregnancy
• Genetic testing can help in planning delivery and postnatal outcomes

Counseling for genetic disorders and testing limitations:

• Loss of DNA can lead to the need for further testing
• Microarray or exome testing may not pick up all abnormalities

Importance of definitive diagnosis for intellectual disability:

• Genetic counseling for potential carriers and affected children
• Emphasizing limitations of prenatal scanning and testing

Neurodevelopmental problems have a higher risk than baseline in certain populations:

• Baseline risk of neurodevelopmental problems is 12% in general, 8-13% in certain populations
• Risk of epilepsy is much higher, as high as 16%

Prenatal imaging may not differentiate complex and isolated cases:

• Postnatal imaging and thorough clinical examination are important
• Counseling should not vary between hyperplastic or dysgenetic corpus callosum cases

Next generation sequencing and prenatal MRI assist in prognosis and management:

• MRI can pick up additional findings in 8-12% of cases
• Follow-up and involving specialists such as cardiologist is crucial postnatally

Good prognosis to be communicated cautiously:

• Limitations of scanning should be explained
• Corpus callosum development to be monitored till 20 weeks

Delayed anomaly scan to 20-22 weeks is better for picking up ultrasound findings:

• Biometry of corpus callosum should be looked at earlier than 20 weeks
• Reassuring patients can lead to delayed follow-ups, so proper scheduling is important

Discussion on a case report at 25 weeks and five days:

• Highlighted the absence of cavum of the septum pellucidum
• Explained the presence of a pseudo cavum and its implications

MRI confirmed partial agenesis of corpus callosum:

• Embryological residue formed well in the posterior part
• Primitive corpus callosum arrested in dorsal migration

Normal hippocampus and temporal lobe asymmetry rule out the possibility of developing epilepsy.:

• Isolated agenesis considerably reduces the possibility of epilepsy.
• MRI plays an important role in evaluating neurodevelopmental outcome, with a score of <=3 indicating excellent outcome.

Tractography and cryptography revolutionized understanding of corpus callosum:

• Normal DTI study of a normal corpus callosum in fetus
• Presence of aberrant bundles indicates partial agenesis and connectivity

Importance of KVM septum pellucidum in prenatal scanning:

• KVM septum pellucidum should be carefully examined during prenatal scanning to identify abnormalities
• Neural sonogram and MRI should be considered for further evaluation and confirmation of diagnosis

Offer a multi-disciplinary approach:

• Involving genetics, MRI specialist, fetal medicine specialist, and pediatric neurologist
• Fun facts about the corpus callosum

Discussion on microarray and diagnosis techniques:

• Lack of widespread use of certain diagnostic techniques
• Challenges in obtaining accurate images and results

Debate on diagnosing condition in early trimester:

• Challenges of diagnosing condition in early trimester due to embryonic development
• Importance of waiting until at least 24 weeks for accurate diagnosis

Patient's panic should not be our problem:

• Patients must learn to accept anxiety and panic as part of the process
• We should not take on the responsibility of relieving all patient anxieties

Suggestion for collaboration and data sharing:

• Suggests pooling cases and outcomes for more robust data
• Emphasizes the need for diverse data collection

"Understanding and Addressing Common Challenges in Fetal Medicine"

Discussion on common scenarios in day-to-day practice:

• Rapid advances in imaging and fetal medicine are leading to more subtle abnormalities and malformations being detected
• Termination of pregnancy is no longer the easiest solution, and there are various aspects and management options to consider

Patient's complex medical history and decision-making:

• Patient had previous pregnancy complications including hypoplastic left heart, growth restriction, and eclampsia
• Subsequent pregnancy was conceived via IVF and posed higher risk, requiring timely intervention

Taking action to prevent complications in pregnancy is crucial.:

• It's important to follow rules and guidelines to prevent trouble ahead.
• Research shows that taking action can shift the endpoint of the disease and reduce maternal mortality.

Early screening for preclampsia is crucial:

• 27% incidence of preclampsia in some parts of India
• Early screening can predict personalized risk and improve perinatal outcome

Early intervention for hypertensive patients before 16 weeks of pregnancy.:

• Changes in blood vessel structure and size during pregnancy.
• Prevention and detection of hypertensive conditions for better management.

Monitoring pregnancy changes for better risk assessment:

• Shifting to competing risk approach to update risk calculations
• Utilizing mathematical modeling and software for real-time risk assessment

Measurement of mean arterial pressure is crucial:

• Proper measurement of mean arterial pressure is described in literature and on YouTube
• It's important to prioritize patient well-being over cost and document all procedures

Monitoring PLGF levels is critical for pregnancy outcomes.:

• PLGF levels above 85 indicate a disastrous situation.
• Regular screening and surveillance help in predicting and managing potential complications.

Manage high, low, and intermediate risk pregnancies with appropriate screening and follow-up:

• For high-risk pregnancies, start frequent screening from 24 weeks onwards and repeat if clinically suspicious
• For low-risk pregnancies, call back at 36 weeks; for intermediate risk, reassess at 30 or 34 weeks

Compromising on healthcare for women's scans is unacceptable.:

• Governments must prioritize first trimester scans for women, especially those at risk.
• Developing and utilizing specific tests for detecting health issues in women's urine is vital.

Maternal cardiac function:

• Discussion on the development and use of a new screening method for preeclampsia.
• Presentation of a case of CPAM (Congenital Pulmonary Airway Malformation) in a 29-year-old pregnant woman.

Lung abnormalities and vascular supply in fetus:

• Well-defined triangular legion homogeneously echogenic in the left lung
• Dual vascular supply confirmed by systemic vessel from aorta and paired pulmonary artery and vein

The lung lesion showed signs of resolving and becoming smaller.:

• The complete lung was homogeneous with no cystic changes.
• The baby was normal and showed no respiratory symptoms.

Prognostic factors and differential diagnosis:

• Proliferation of terminal bronchioles is radiologically classified as solid or cystic
• Key prognostic factors are size of lesion, presence of C, and development of hydrops

Ultrasound helps in counseling and planning postnatal outcomes.:

• Understanding natural formation aids in managing strategies and preparing the pediatric team.
• Bright lung echogenicity and midline shift help in identifying and assessing thoracic lesions.

Different types of lesions in practice:

• Pulmonary sequestration and abnormality associated with cystic or solid lesion
• Demonstration of systemic blood supply for identification

Poor development of bronchial cartilage leads to collapse of the bronchus.:

• This collapse functions as a one-way valve, leading to accumulation of amniotic fluid in the AL.
• Prenatal regression of congenital lung malformations does not rule out postnatal respiratory complications.

Respiratory support may be needed within 24 hours:

• Consider surgery within two years after birth
• Prognosticating factors include gestational age, lesion size, location, and associated abnormalities

The size of the lesion is an important factor in prenatal prognostic:

• The size of the lesion can remain stable or change compared to fetal growth
• It can be classified into categories and measured for ultrasound reports

Fetus with conal lar malformation postnatal care:

• Respiratory support or surgery required within 24 hours to 2 years after birth
• Postnatal CT and follow-up for at least two years is crucial

Fetal ventricular megal is a common finding with potential implications for fetal health and development.:

• It is associated with chromosomal abnormalities and fetal infections.
• Its presence prompts comprehensive structural evaluation and consideration of associated CNS anomalies.

Criteria for measuring ventricle dilation:

• Measuring the medial wall distance from the ventricular wall to the choid plexus
• Standardization for measuring lateral ventricles to ensure accuracy

Ventricular megal and atrial diameter:

• Ventricular megal is associated with obstructive anomalies
• Extended neurogram and proper midline sagittal view are crucial for evaluation

Neurosonogram for comprehensive assessment:

• Start with biometry, calvarium, and ventricles
• MRI complements ultrasound after 26 weeks for additional findings

Absence of Corpus Callosum and Associated Abnormalities:

• A short or wide CSP on the sagittal view indicates partial agenesis of the Corpus Callosum.
• Ventricular abnormalities are common and may be associated with other major CNS abnormalities.

Obstructive hydris can lead to increased pressure within the cranium:

• Look for increased space between the brain and the overlying calvarium, indicating cerebral atrophy
• Dilated cations can lead to severe obstructive dilation of the lateral ventricles and third ventricle, resulting in paranal thinning

Ventricular megal requires thorough testing and regular monitoring:

• Chromosomal microarray or clinical exom testing is important for diagnosis
• Infections, cerebral atrophy, and CNS inflammation can cause ventricular megal

Ventricular megal increases risk of neurodevelopmental delay:

• Size of ventricular megal influences neurodevelopmental outcome
• Severity of ventricular megal affects the likelihood of abnormal neurodevelopmental outcome

Pulmonary sequestration genetic testing is not mandatory:

• Early ultrasound examination is planned from 18 to 24 weeks gestation
• Postnatal follow-ups are mandatory, including a CT scan within 4 days to one week postnatal

Discussing the challenges of evaluating breach babies at 24 weeks.:

• Genetic testing and infection observation are crucial for treatment.
• Difficulty in getting comprehensive views on ultrasound in breach babies.

Obtaining permissions takes 6-7 weeks on average.:

• Encouraging members to subscribe to SFM YouTube channel.
• Expressing gratitude to hosts and trade partners.