{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:28:14Z","timestamp":1790947694311,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether in fetuses with open spina bifida (OSB) the tentorium can be seen to be displaced downwards and vertically oriented by the time of the 11\u201313\u2010week scan and whether this is reflected in an alteration of the brainstem\u2013tentorium (BST) angle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population was recruited between 2015 and 2020 from three fetal medicine referral centers and comprised a control group and a study group of pregnancies with OSB. The control group was recruited prospectively and included singleton pregnancies with a normal sonographic examination after first\u2010trimester combined screening for chromosomal abnormalities and normal outcome. The study group was selected retrospectively and included all cases with OSB between 2015 and 2020. All cases underwent detailed ultrasound assessment at 11\u2009+\u20090 to 13\u2009+\u20096\u2009weeks' gestation. The position of the torcular Herophili (TH) was identified in the midsagittal view of the fetal brain with the use of color Doppler and was considered as a proxy for the insertion of the tentorium on the fetal skull. The BST angle was calculated in the same view and was compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty normal fetuses were included in the control group and 22 fetuses with OSB in the study group. In both groups, the BST angle was found to be independent of gestational age or crown\u2013rump length (<jats:italic>P<\/jats:italic>\u2009=\u20090.8815, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.0003861 in the controls, and <jats:italic>P<\/jats:italic>\u2009=\u20090.2665, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.00978 in the OSB group). The mean BST angle was 48.7\u2009\u00b1\u20097.8\u00b0 in controls and 88.1\u2009\u00b1\u20091.18\u00b0, i.e. close to 90\u00b0, in fetuses with OSB. Comparison of BST\u2010angle measurements between the control group and cases with OSB showed a statistically significant difference (<jats:italic>P<\/jats:italic>\u2009=\u20090.0153). In all fetuses with OSB, the downward displacement of the TH and tentorium was clearly visible at the 11\u201313\u2010week scan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In fetuses with OSB, the BST angle is significantly larger than in normal controls, with the tentorium being almost perpendicular to the brainstem. This sign confirms the inferior displacement of the tentorium cerebelli with respect to its normal insertion on the occipital clivus as early as the first trimester of pregnancy and is useful in the diagnosis of Chiari\u2010II malformation at this early stage. In fetuses with OSB, the low position of the tentorium and TH is clearly visible, even subjectively, at the 11\u201313\u2010week scan. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23697","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T19:55:32Z","timestamp":1623700532000},"page":"49-54","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Low torcular Herophili position and large brainstem\u2013tentorium angle in fetuses with open spinal dysraphism at 11\u201313\u2009weeks' gestation"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1492-8868","authenticated-orcid":false,"given":"P.","family":"Volpe","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL  BA Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"De Robertis","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL  BA Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL  BA Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Boito","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Volpe","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Votino","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL  BA Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-9597","authenticated-orcid":false,"given":"N.","family":"Persico","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico  Milan Italy"},{"name":"Department of Clinical Science and Community Health University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9089-7119","authenticated-orcid":false,"given":"R.","family":"Chaoui","sequence":"additional","affiliation":[{"name":"Center for Prenatal Diagnosis and Human Genetics  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7329"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2632"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000365989"},{"key":"e_1_2_7_5_1","first-page":"151","article-title":"Detection of Spina Bifida by First Trimester Screening\u00a0\u2013\u00a0Results of the Prospective Multicenter Berlin IT\u2010Study","volume":"38","author":"Chen FC\u2010K","year":"2017","journal-title":"Ultraschall Med"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4598"},{"key":"e_1_2_7_7_1","first-page":"1","article-title":"Maxillo\u2010occipital line: a sonographic marker for screening of open spina bifida in the first trimester of pregnancy","volume":"29","author":"Ramkrishna J","year":"2018","journal-title":"J Matern Fetal Neonatal 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