Avramenko T.V., Shevchenko A.A., Gordienko I.Y.
Arnold-Chiari malformation. Prenatal and clinical observations
Abstract.
The paper is dedicated to a severe congenital anomaly of the central nervous system–Arnold-Chiari malformation, the basic historical, clinical, pathophysiological aspects and issues of its classification, prenatal diagnosing and treatment being presented. Clinical case of Arnold-Chiari malformation of the 2nd type in combination with lower thoracic and lumbar meningomyelocele and that of Arnold-Chiari malformation of the 1st type in combination with agenesis of the corpus callosum are described. In case of Arnold Chiari malformation of the 2nd type pathological symptoms are severer and begin to manifest in infants and early childhood in the form of nystagmus, apnea, stridor, vocal cords paresis, dysphagia with regurgitation, impaired tone in the limbs. Considering the presence of spina bifida in this type of malformation, surgical intervention during the first days of life becomes necessary. The necessity to use modern method of neurovisualization - magnetic resonance imaging for the improvement of prenatal diagnosing of congenital anomalies of the central nervous system is also grounded. It enables the reduction of perinatal and infant mortality and primary disability. Magnetic resonance imaging is a noninvasive method of visualization of the anomalies of the CNS of the fetus with high resolving power. This involves a comparison of the obtained indices with those of prenatal ultrasound. Complex application of ultrasound and magnetic resonance imaging (when indicated) greatly improves the quality of prenatal diagnosing. Anatomical verification of the pathology of the fetal brain structures using the MRI can be crucial for the final diagnosis in complicated and disputable cases, and the development of modern medical technologies in pediatric surgery and neonatology requires accurate nosological and topical diagnosing.
Key words: Arnold-Chiari malformation, prenatal diagnosing, magnetic resonance imaging, treatment, children.
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