Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?

• Published in: Neuroradiology Vol. 64; no. 10; pp. 2069 - 2076
• Main Authors: Ceylan, Arda H., Nascene, David R., Huang, Haitao, Luedemann, Christopher, Rubin, Nathan, Özütemiz, Can
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2022; Springer Nature B.V
• Subjects: Apgar score; Birth injuries; Birth weight; Brain research; Cesarean section; Edema; Epidural; Evaluation; Fetuses; Gestational age; Hematoma; Hemorrhage; Imaging; Magnetic resonance imaging; Medical imaging; Medical records; Medicine; Medicine & Public Health; Neonates; Neuroimaging; Neurological complications; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Paediatric Neuroradiology; Patients; Pediatrics; Radiology; Sinuses; Thickening; Vagina; Epidural space; Newborn; Epidural edema; MRI; Torcular pseudomass; Pitfall
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-022-02981-2

Purpose
The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as “torcular pseudomass” (TP). We aim to identify the frequency of TP and possible associations with delivery.
Methods
Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student
t
and chi-square tests.
Results
TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (
p
 > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week.
Conclusion
TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.