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Definition: In 1914, Blackfan and Dandy described some alterations of the posterior
fossa as cystic dilatation of the fourth ventricle, hypoplasia of the cerebellar vermis,
separation of the cerebellar hemispheres, dilatation of the mesencephalic aqueduct
and absence of the mediate and lateral apertures of the fourth ventricle. These
abnormalities were referred to as Dandy-Walker malformation. In the 1970 and 80
different definitions were introduced for similar abnormalities of posterior fossa and
then the classic definition of the Dandy-Walker malformation.
The term Dandy-Walker syndrome was introduced to define the association of
ventriculomegaly,
increase of the cisterna magna and
defect of the cerebellar vermis with a communication of the cyst with the
fourth ventricle.
inferior portion is not seen. Enlargement of the cistern magna is considered when greater than
10mm in the antero-posterior axis. The hydrocephaly was already considered as an element
of the diagnosis, but recent studies suggest that it is not always present in the birth, but
usually appear in the first months of life.
Differential diagnosis: Arachnoid cyst can be differentiated by the size and appearance of
the cerebellum. Even in the second and third trimester the insonation angle can mistake the
diagnosis. In the cases of doubt a sagittal plane helps visualization of the vermis. A
transvaginal scan if possible will result in a better view too.
Associated anomalies: Postnatal studies indicate a frequency from 50 to 70% of associated
anomalies. Other anomalies include ventriculomegaly, other midline anomalies, corpus
callosum agenesis, holoprosencephaly, cephaloceles, polycystic kidneys, heart defects and
cleft lip and palate. The chromosomal abnormalities include trisomies 18, 13 and Turner
syndrome.
Prognostic: The classic malformation is usually clinically manifest in the first year of
life with symptoms of hydrocephaly and/or neurological symptoms. The mortality is
24% but with current neurosurgical techniques mortality has been decreasing. The
intellectual development in the survivors is controversial. Intellectual deficit may be in
teh range of 40 to 70% of the cases. The isolated defect (no aneuploidies or other
anomalies) seems to be associated with better prognostic.
Management: There is no modification of standard obstetric management.
Cesarean delivery is indicated only if macrocrania is present.
References:
1 - R. Achiron, A. Achiron. Transvaginal ultrasonic assessment of the early fetal brain. Ultras Obstet
Gynecol 1991;1(5):336-344
2 - G. Pilu, I. Goldstein, E. A. Reece, A. Perolo, M. P. Foschini, J. C. Hobbins, L. Bovicelli.
Sonography of fetal Dandy - Walker malformation: a reappraisal Ultras Obstet Gynecol
1992;2(3):151-157
3 - B. Ulm, M. R. Ulm, J. Deutinger, G. Bernaschek. Dandy-Walker malformation diagnosed before
21 weeks of gestation: associated malformations and chromosomal abnormalities. Ultras Obstet
Gynecol 1997;10(3):167-170
4 Gianluigi Pilu, Antonella Visentin, Barbara Valeri. The Dandy-Walker complex and fetal
sonography. Ultras Obstet Gynecol 2000;12(2):115-117
5 Nyberg DA, Pretorius DH. Cerebral Malformations. In: Nyberg DA, Mahony BS, Pretorius DH, eds.
Diagnostic ultrasound of fetal anomalies. Lippincott Willians and Wilkins, 2003.; 237-243.
5 - JA Estroff, MR Scott, and BR Benacerraf. Dandy-Walker variant: prenatal sonographic features
and clinical outcome. Radiology 1992; 185: 755.
6 - MC Chang, SA Russell, PW Callen, RA Filly, and RB Goldstein. Sonographic detection of inferior
vermian agenesis in Dandy-Walker malformations: prognostic implications. Radiology 1994; 193: 765.