{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:56:38Z","timestamp":1786978598171,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Recently, it was noted that fetuses with open spina bifida (OSB) may have a midline cystic structure evident on ultrasound. Our aims were to determine the prevalence of this cystic structure, shed light on its pathophysiology and investigate the association between its presence and other characteristic brain findings in fetuses with OSB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a single\u2010center retrospective study of all fetuses with OSB and available cineloop images in the axial plane referred to the Ontario Fetal Centre, Toronto, Canada, between June 2017 and May 2022. Ultrasound and magnetic resonance imaging (MRI) data obtained between 18\u2009+\u20090 and 25\u2009+\u20096\u2009weeks were reviewed in search of a midline cystic structure. Pregnancy and lesion characteristics were collected. Transcerebellar diameter (TCD), clivus\u2013supraocciput angle (CSA) and additional brain abnormalities (abnormal cavum septi pellucidi (CSP), abnormal corpus callosum (CC) and periventricular nodular heterotopia (PNH)) were assessed. In cases of\n                      <jats:italic>in\u2010utero<\/jats:italic>\n                      repair, imaging findings were reviewed postoperatively. In cases of termination, neuropathological findings were reviewed, if available.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 76 fetuses with OSB, 56 (73.7%) had a suprapineal cystic structure on ultrasound. The percentage of agreement between ultrasound and MRI detection was 91.5% (Cohen's kappa coefficient, 0.78 (95%\u2009CI, 0.57\u20130.98)). Brain autopsy in terminated cases revealed a dilatation of the posterior third ventricle, with redundant tela choroidea and arachnoid forming the membranous roof of the third ventricle, anterior and superior to the pineal gland. A cyst wall could not be identified, indicating that the structure was a pseudocyst. The presence of the pseudocyst was associated with a smaller CSA (pseudocyst absent, 62.11\u2009\u00b1\u20099.60\u00b0\n                      <jats:italic>vs<\/jats:italic>\n                      pseudocyst present, 52.71\u2009\u00b1\u20098.22\u00b0;\n                      <jats:italic>P\u2009=<\/jats:italic>\n                      \u20090.04). When the pseudocyst was present, its area was correlated inversely with TCD (\n                      <jats:italic>r<\/jats:italic>\n                      , \u22120.28 (95%\u2009CI, \u22120.51 to \u22120.02);\n                      <jats:italic>P\u2009=<\/jats:italic>\n                      \u20090.04). Fetal surgery did not have any impact on the growth rate of the pseudocyst (fetal surgery, 5.07\u2009\u00b1\u20093.29\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/week\n                      <jats:italic>vs<\/jats:italic>\n                      expectant management, 4.35\u2009\u00b1\u20093.17\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/week;\n                      <jats:italic>P\u2009=<\/jats:italic>\n                      \u20090.58). The presence of the pseudocyst was not associated with abnormal CSP, CC or presence of PNH. None of the cases with available postnatal follow\u2010up required surgical procedure related to the pseudocyst.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately 75% of all OSB cases have a suprapineal pseudocyst. Its presence is associated with the degree of hindbrain herniation but not with abnormalities of the CSP and CC or presence of PNH. Thus, it should not be regarded as additional brain pathology and should not preclude fetuses from undergoing fetal surgery for OSB. \u00a9 2023 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.26221","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T12:24:45Z","timestamp":1681475085000},"page":"383-390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Midline suprapineal pseudocyst in brain of fetuses with open spina bifida"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7388-1414","authenticated-orcid":false,"given":"Y.","family":"Kunpalin","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology Mount Sinai Hospital and University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4453-1167","authenticated-orcid":false,"given":"J.","family":"Sichitiu","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology Mount Sinai Hospital and University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Krishan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging Hospital for Sick Children and University of Toronto Toronto Canada"},{"name":"Ontario Fetal Centre Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Blaser","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging Hospital for Sick Children and University of Toronto Toronto Canada"},{"name":"Ontario Fetal Centre Toronto 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