022. Incidence, follow-up and postnatal outcome of children with neurologic abnormalities on fetal MRI

Authors: Nicole Eva Hernandez

Magnetic resonance imaging (MRI) has been increasingly employed to assess intrauterine fetal anomalies. As more pediatric neurosurgeons receive prenatal referrals of various structural anomalies of the central nervous system (CNS), there will be greater impetus to understand the most common findings and their natural histories.Methods: We performed a single-center retrospective review of fetal MRIs performed between January 2012 and December 2020. CNS abnormalities on the fetal MRI, associated extra-CNS findings, and suspicion for genetic abnormality or syndromes were noted. Postnatal clinical status and interventions were assessed.
Between January 2012 and December 2020, a total of 263 fetal MRIs were performed; of which, 114 maternal-fetal pairs met the inclusion criteria. This cohort included 67 males (58.8%) with a mean postnatal follow-up of 29.8 ± 25.0 months. The fetal MRIs were performed at 27.4 ± 3.8 weeks of gestational age. The most frequently reported CNS abnormalities were ventriculomegaly (57.0%), agenesis or thinning of the corpus callosum (31.6%), Dandy-Walker complex (21.1%), cortical neuronal migrational disorders (17.5%), and abnormalities of the septum pellucidum (16.7%). Twenty-one children (18.4%) required neurosurgical intervention, at a mean age of 2.3 ± 3.4 months. The most common surgical conditions include myelomeningocele, moderate-severe ventriculomegaly, encephalocele, and arachnoid cyst. Corpus callosum agenesis or thinning were associated with developmental delay (p=0.023) and systemic anomalies (p=0.05) while DWC was not.
18.4% of prenatal neurosurgical consultations resulted in surgical intervention in early infancy. The majority of mild ventriculomegaly and DWC cases are benign and not associated with developmental or surgical sequelae. Patients with corpus callosum abnormalities should be concurrently referred to neurology for developmental assessments.