Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

iii

ULTRASONOGRAPHY OF

THE PRENATAL BRAIN

Third Edition

Ilan E. Timor-Tritsch, MD

Professor of Obstetrics and Gynecology Director, Division of Obstetrical and

Gynecological Ultrasound Department of Obstetrics and Gynecology New York University School of Medicine New York, New York

Ana Monteagudo, MD

Professor of Obstetrics and Gynecology Director, Bellevue Medical Center Obstetrics

and Gynecology, Ultrasound Unit Fellowship Director Maternal-Fetal Medicine Department of Obstetrics and Gynecology New York University School of Medicine New York, New York

Gianluigi Pilu, MD

Associate Professor of Obstetrics and Gynecology Department of Obstetrics and Gynecology University of Bologna, Italy Bologna, Italy

Gustavo Malinger, MD

Associate Clinical Professor of Obstetrics

and Gynecology Director, Division of Prenatal Diagnosis Co-Director, Fetal Neurology Clinic Department of Obstetrics and Gynecology Edith Wolfson Medical Center Sackler School of Medicine Tel Aviv University Holon, Israel

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Mortimer G. Rosen, MD

1931–1992

This book is dedicated to Mortimer G. Rosen, friend and mentor, whose early research on the fetal brain was an inspiration to me and many other young researchers struggling to understand the fetal brain. By creating the necessary clinical and scientific environment for such studies, he became very much a part of its “birth.” Many years ago, probably at the beginning of his career as a perinatologist, Dr. Rosen recognized the importance of studying the human fetal brain. Surrounded by a growing group of enthusiastic scholars, including residents, maternal-fetal fellows, biomedical engineers, and biochemists, he pursued his research on one of the most difficult subjects: the physiology and the physiopathology of the fetal central nervous system.

Dr. Rosen believed that the then available systems for monitoring fetal health and well-being were inadequate for predicting the intellectual functioning of the neonatal brain. He was always seeking new ways for studying the developing human brain.

When ultrasonography was introduced, Dr. Rosen was among the first to encourage its use in the study of

fetal behavioral studies. When he saw the first detailed, crystal clear pictures of the prenatal central nervous system achieved by high frequency transvaginal imaging, he immediately understood the enormous potential of this laboratory technique.

His scientific integrity and skepticism stimulated us to become experts in our field, and furnish objective results to prove the clinical value of high resolution brain scanning of the fetus.

When I presented him with the outline of this book, he was not only supportive, but promised to contribute a special chapter on cerebral palsy, a subject in which he was extremely interested. This is the only time he let us down. The chapter never got further than its introduction. Mort Rosen—my mentor and friend, as well as enthusiastic supporter of our endeavors—passed away in 1992, not living long enough to see the fruits of his labors.

To you, Mort Rosen, in loving memory. I think you would be proud of this work.

Ilan E. Timor-Tritsch, MD

Ilan E. Timor-Tritsch, MD Ana Monteagudo, MD Gianluigi Pilu, MD Gustavo Malinger, MD

To my family.

Ilan E. Timor-Tritsch, MD

To my family: my son, Benjamin; my parents, Edith and Miguel; my sister, my niece, and my

brother-in-law: Edith A, Carolinna, and Michael who inspired, supported, and encouraged me.

Ana Monteagudo, MD

To my wife and my daughter. Antonella and Isabella, you have all my love.

Gianluigi Pilu, MD

To papá y mamá with love, you will be in my heart forever. To Eyal, Andrés y Nicole, I am very

proud of you. To Patricia, you make everything possible.

Gustavo Malinger, MD

Contributors ........................................................... ix

Foreword ................................................................. xi

Prefaces .................................................................. xiii

Acknowledgments .............................................. xvii

1. Prenatal Development of the Brain ............. 1

Ronan O’Rahilly and Fabiola Müller

2. Normal Two- and Three-Dimensional Neurosonography

of the Prenatal Brain .................................... 15

Ilan E. Timor-Tritsch, Ana Monteagudo,

and Maria Del Rio

3. Biometry of the Fetal Brain ...................... 103

Natan Haratz-Rubinstein, Ana

Monteagudo, and Ilan E. Timor-Tritsch

4. Ventriculomegaly ....................................... 171

Gianluigi Pilu, Gustavo Malinger,

and Selim Buyukkurt

5. Anomalies of Dorsal Induction ............... 179

Ana Monteagudo

and Ilan E. Timor-Tritsch

6. Anomalies of Ventral Induction ............. 227

Gianluigi Pilu, Selim Buyukkurt,

and Gustavo Malinger

7. Malformations of Cortical

Development ............................................... 247

Gustavo Malinger, Ants Toi,

Liat Ben-Sira, and Tally Lerman-Sagie

8. Anomalies of the Cerebellum .................. 283

Gianluigi Pilu, Gustavo Malinger,

and Selim Buyukkurt

9. Intrauterine Infections Affecting

the Brain ....................................................... 303

Gustavo Malinger

and Tally Lerman-Sagie

10. Intrauterine Insults: Fetal Stroke

and Destructive Processes ........................ 321

Ana Monteagudo, Gianluigi Pilu,

Gustavo Malinger, Selim Buyukkurt, and Ashwin Jadhav

11. Intracranial Cysts ....................................... 351

Eran Bornstein, Ana Monteagudo,

and Ilan E. Timor-Tritsch

12. Metabolic Disorders .................................. 373

Asuri N. Prasad, Gustavo Malinger,

and Tally Lerman-Sagie

13. Tumors of the Brain .................................. 393

Israel Meizner

14. The Fetal Eye ............................................... 407

Zeev Blumenfeld

and Moshe Bronshtein

15. Fetal Cerebral Circulation ........................ 427

Ritsuko K. Pooh and Shimon Degani

16. Craniofacial Anomalies ............................. 447

Gianluigi Pilu, Gustavo Malinger,

and Tullio Ghi

17. Vertebral Anomalies .................................. 467

Yinon Gilboa, Eldad Katorza,

and Reuven Achiron

Index ...................................................................... 477

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Contributors ix

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CONTRIBUTORS

Reuven Achiron, MD

Professor of Obstetrics and Gynecology Division of Prenatal Diagnosis Department of Obstetrics and Gynecology The Chaim Sheba Medical Center Tel Hashomer, Israel (Chapter 17)

Liat Ben-Sira, MD

Division of Pediatric Radiology Department of Radiology Tel Aviv Medical Center Sackler School of Medicine Tel Aviv University Tel Aviv, Israel (Chapter 7)

Zeev Blumenfeld, MD

Associate Professor Director, Reproductive Endocrinology Department of Obstetrics and Gynecology Rambam Medical Center Technion-Faculty of Medicine Haifa, Israel (Chapter 14)

Eran Bornstein, MD

Maternal-Fetal Medicine Director of Obstetrical Service Lenox Hill Hospital/North Shore LIJ New York, New York (Chapter 11)

Moshe Bronshtein, MD

Faculty of Social Welfare & Health Sciences University of Haifa AL-KOL Institute of Ultrasound Haifa, Israel (Chapter 14)

Selim Buyukkurt, MD

Department of Obstetrics and Gynecology University of Cukurova School of Medicine Adana, Turkey (Chapters 4, 6, 8, 10)

Shimon Degani, MD

Professor of Obstetrics and Gynecology Faculty of Medicine Technion-Israel Institute of Technology Director of Ultrasound Unit Department of Obstetrics and Gynecology Bnai Zion Medical Center Haifa, Israel (Chapter 15)

Maria Del Rio, MD, PhD

Department of Obstetrics and Gynecology Hospital General Hospitalet Barcelona, Spain (Chapter 2)

Tullio Ghi, MD

Department of Obstetrics and Gynecology University of Bologna Bologna, Italy (Chapter 16)

Yinon Gilboa, MD

Department of Obstetrics and Gynecology The Chaim Sheba Medical Center Sackler School of Medicine Tel Aviv University Tel Aviv, Israel (Chapter 17)

Natan Haratz-Rubinstein, MD

New York Methodist Hospital Advanced Womens Imaging Brooklyn, New York (Chapter 3)

Ashwin Jadhav, MD, MS

Assistant Professor Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology UMDNJ-Robert Wood Johnson Medical School New Brunswick, New Jersey (Chapter 10)

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CONTENTS

CONTRIBUTORS