Fetal Spine Part 1

Question 1

When scanning the fetal spine, what is very important to see?

Answer 1

intact skin line

Question 2

Most congenital spinal problems are the result of defective closer of the neural tube during what week of embryonic development?

Answer 2

4th

Question 3

Neural tube defects are associated with elevated ______.

Answer 3

AFP

Question 4

Spinal dysraphism is a broad term given to a group of anomalies related to:

Answer 4

any abnormalities of the dorsum of the embryo
or
neurological disorders related to malformations of spinal cord (NTD fall under this group)

Question 5

Spinal dysraphism can be divided into 2 pathological entities:

Answer 5

open spinal dysraphism

closed spinal dysraphism

Question 6

What are examples of open spinal dysraphism?

Answer 6

meningocele

myelomenigocele

Question 7

What are examples of closed spinal dysraphism?

Answer 7

spinal dermal sinus
lipomyelomenigocele
diastematomyelia
neurentric cysts
thickened filum terminale

Question 8

What is spinal dermal sinus

Answer 8

an epithelium-lined tract from the skin to the spinal cord, cauda equina or arachnoid

Question 9

What is lipomyelomeningocele

Answer 9

usually presents as a subcutaneous fatty mass just above the intergluteal cleft

Question 10

What is diastematomyelia

Answer 10

split cord malformation

Question 11

What is neurentric cysts

Answer 11

type of foregut duplication cyst, associated either with vertebral or CNS abnormalities
most commonly occur in thoracic region

Question 12

Tight filum terminale syndrome is associated with what?

Answer 12

vertebral body deformities and spina bifida

Question 13

Tight filum terminale syndrome:

Answer 13

incomplete involution to distal spinal cord

results in neurological deficiencies, pain, bowel dysfunction

Question 14

What will be seen sonographically for tight filum terminale syndrome?

Answer 14

abnormally thickened filum terminale

sometimes with cysts/lipoma

Question 15

For tight filum terminale syndrome, the diameter of the filum terminale should not exceed:

Answer 15

2mm

Question 16

Tethered spinal cord is

Answer 16

attached to surrounding tissue

Question 17

Neural tube defects involving ___________ _______ are referred to as

Answer 17

vertebral arches, spina bifida

Question 18

What is common to all types of spina bifida?

Answer 18

non-fusion of the embryonic halves of the vertebral arches

Question 19

The majority of spina bifida occurs where?

Answer 19

lumbosacral region

Question 20

Severe spina bifida involves the

Answer 20

spinal cord

Question 21

What is the most severe form of spina bifida

Answer 21

myelomenigocele

Question 22

What is the mildest form of SB

Answer 22

occulta

one or more vertebrae are malformed and covered with skin

Question 23

Many children with SB also have

Answer 23

hydrocephalus

Question 24

What’s the difference between open and closed SB?

Answer 24

closed is covered by skin, open is not

Question 25

Meningocele

Answer 25

meningeal membrane and CSF protrude through defect in vertebral arch (skin is mostly intact)

Question 26

Myelomeningocele

Answer 26

meningeal membrane, CSF, and neural tissue (spinal cord) protrude through defect (skin partly covers defect)

Question 27

Myeloschisis and rachischisis are often interchangable terms. True or false

Answer 27

True

Question 28

Myeloschisis

Answer 28

open, flattened spinal cord, exposed through a wide defect in the posterior neural arch and defect in musculature and skin (no skin or meningeal covering)

Question 29

Rachischisis

Answer 29

complete SB. cleft through entire spine from cervical to sacral region- open, flattened spinal cord (entire spinal cord is exposed)

Question 30

SB occulta (or closed)

Answer 30

minor and insignificant abnormality
no clinical symptoms
rarely diagnosed prenatally

Question 31

What are indications of SB occult?

Answer 31

dimple, tuft of hair or red mark on the back

Question 32

Most spina bifida cases are what classification? How much?

Answer 32

Open – 80%

Question 33

What type of spina bifida is most common?

Answer 33

Myelomeningocele (also most severe.. myeloschisis is most severe form of myelomeningocele)

Question 34

Spina Bifida Aperta– Cystica involves

Answer 34

protrusion of the meninges and spinal cord through the defect in the posterior vertebral arch

Question 35

If a mass contains only meninges with CSF, the anomaly is called

Answer 35

SB w/ meningocele.

spinal cord and roots are in their normal position, but there may be spinal cord anomalies

Question 36

Meninges protrude _____ _____ _____ through the cleft in the malformed _________ _________.

Answer 36

under the skin, vertebral arch

Question 37

Spina bifida apeta- cystica. If the spinal cord and/or nerve roots protrude in the mass, the defect is called

Answer 37

SB w/ myelomeningocele

Question 38

What’s the most severe form of myelomeningocele?

Answer 38

myeloschisis

Question 39

The more ______ the level of defect, the more severe the associated nerve dysfunction and paralysis may be.

Answer 39

cranial

Question 40

There is a small skin layer covering the nerve tissue with myeloschisis. True or false

Answer 40

False- the nerve tissue is fully bare and a dermal or meningeal covering is absent

Question 41

Many individuals with SB have an associated abnormality of the cerebellum, called:

Answer 41

Arnold Chiari II malformation

Question 42

The cerebellum is larger in those individuals with SB. True or false.

Answer 42

False- cerebellum is smaller, especially those with higher lesion levels

Question 43

What is abnormally developed in individuals with spina bifida myelomeningocele? What percentage?

Answer 43

corpus callosum

70-90%

Question 44

What are some sonographic signs of spina bifida seen in the head?

Answer 44

nonvisualization of cisterna magna
deformation of cerebellum (banana sign)
concave frontal bones (lemon sign)
dilation of lateral ventricles
Chiari II malformation (97%)
BPD lower than expected