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Fetal macrocrania: diagnosis, delivery and outcomes

Abstract

Objective:

To describe fetal macrocrania including prenatal diagnosis, delivery considerations and clinical outcomes.

Study Design:

A retrospective case series was developed by reviewing 26 885 ultrasounds performed between 1 March 2003 and 30 June 2007 for the prenatal diagnosis of macrocrania. Medical records of each mother/infant pair were reviewed for demographic information, ultrasound findings, obstetric management and outcomes.

Result:

Twenty-three fetuses were diagnosed with macrocrania. Median gestational age at diagnosis was 31.1 weeks (range 18.3–38.1) and at delivery was 36.9 weeks (range 30.7–39.9). Fifteen patients (65%) underwent amniocentesis for karyotype; none were aneuploid but one had a duplication on chromosome 7. All the 23 infants were liveborn. Twenty-one deliveries were by Cesarean (91%), with thirteen of these by classical incision (62%). Of the infants, 5 (22%) died shortly after birth, 16 (70%) were stabilized in the neonatal intensive care unit and were discharged alive and 2 (8%) were transferred to another center and subsequently died. Eighteen babies required ventriculoperitoneal shunting (78%).

Conclusion:

Macrocrania is a diagnosis usually made in children but can also be made prenatally. Fetal macrocrania is usually a result of ventriculomegaly due to an obstructive process to cerebrospinal fluid flow. Abdominal delivery is usually required, often necessitating a classical uterine incision. Targeted ultrasonography, extensive counseling of parents and delivery at a tertiary care center with availability of neurosurgery is recommended.

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References

  1. Dorland, WA, Newman. Dorland's Illustrated Medical Dictionary, 29th edn, WB Saunders Company: Philadelphia, PA, 2000, pp 1043–1044, 1073.

  2. Medina LS, Frawley K, Zurakowski D, Buttros D, DeGrauw AJ, Crone KR . Children with macrocrania: clinical and imaging predictors of disorders requiring surgery. AJNR Am J Neuroradiol 2001; 22 (3): 564–570.

    CAS  PubMed  Google Scholar 

  3. Donat JF . Evaluation of macrocrania using computed tomography. Am J Dis Child 1981; 135 (12): 1118–1121.

    CAS  PubMed  Google Scholar 

  4. Babcock DS, Han BK, Dine MS . Sonographic findings in infants with macrocrania. AJR Am J Roentgenol 1988; 150 (6): 1359–1365.

    Article  CAS  Google Scholar 

  5. Park SW, Cho KH, Shin YS, Kim SH, Ahn YH, Cho KG et al. Helmetlike skull deformity with a large arachnoid cyst. Surg Neurol 2006; 65 (1): 95–98.

    Article  Google Scholar 

  6. Bosnjak V, Besenski N, Marusić-Della Marina B, Kogler A . Cranial ultrasonography in the evaluation of macrocrania in infancy. Dev Med Child Neurol 1989; 31 (1): 66–75.

    Article  CAS  Google Scholar 

  7. Parmeggiani A, Posar A, Giovanardi-Rossi P, Andermann F, Zifkin B . Autism, macrocrania and epilepsy: how are they linked? Brain Dev 2002; 24 (5): 296–299.

    Article  Google Scholar 

  8. Hamza M, Bodensteiner JB, Noorani PA, Barnes PD . Benign extracerebral fluid collections: a cause of macrocrania in infancy. Pediatr Neurol 1987; 3 (4): 218–221.

    Article  CAS  Google Scholar 

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Acknowledgements

No financial support was obtained for this study.

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Correspondence to M R Laye.

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Laye, M., Moore, B., Kosek, M. et al. Fetal macrocrania: diagnosis, delivery and outcomes. J Perinatol 29, 201–204 (2009). https://doi.org/10.1038/jp.2008.196

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  • DOI: https://doi.org/10.1038/jp.2008.196

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