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Counseling in Fetal Medicine: Agenesis of The Corpus Callosum.
MedLine Citation:
PMID:  23024003     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
The aim of this review is to provide up-to-date and evidence based answers to common questions regarding the diagnosis and prognosis of prenatally detected absence of the corpus callosum (ACC). A systematic literature search was performed to identify all reports of ACC and reference lists of articles were identified. ACC involves partial or complete absence of the main commissural pathway that connects the two cerebral hemispheres, and can be isolated (with no other abnormalities) or complex (with other abnormalities coexisting). It is a rare finding and the prevalence is difficult to estimate because of selection bias in reported series. The corpus callosum (CC) can be assessed on ultrasound by direct visualisation, but indirect features such as ventriculomegaly, absence of the cavumseptipellucidi or widening of inter-hemispheric fissure are commonly the reason for detection in a screening population. Careful imaging in a centre with a high level of expertise is required to make a full assessment and to exclude coexisting abnormalities, which may occur in about 46% of fetuses. Where available, MRI appears to be an important adjunct as it allows direct visualization. It can reduce false positive rates on ultrasound and can confirm ACC, it can assess whether this is complete or partial, and it can help in detecting coexisting brain abnormalities not seen on ultrasound. The overall rate of chromosomal abnormality in fetuses with ACC is 18%, but this high rate includes both isolated and complex ACC; more recent studies suggest that chromosomal abnormalities are rare in isolated cases. Nevertheless, postnatal follow up studies suggestthat about 15% of cases thought to be isolated prenatally were found to have associated abnormalities after birth. Neurodevelopmental outcome in isolated ACC was recently reported in a systematic review and suggested normal outcome in about 65-75% of cases. The findings need to be seen in light of the several limitations of existing studies, in terms of study design, selection bias, varying definitions and imaging protocols, ascertainment bias and lack of control groups. These uncertainties mean that antenatal counselling remains difficult and further large prospective studies are needed. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
S Santo; F D'Antonio; T Homfray; P Rich; G Pilu; A Bhide; B Thilaganathan; A T Papageorghiou
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-1
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's, University of London, London, UK.
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