 Good morning, everyone. I'm Dr. Shanthin Roy. I am a postgraduate trainee from Neurocon Short-Time Medical College and Hospital and I would be presenting my paper based on the evaluation of brain abnormalities and infants with myelomeningocene using magnetic resonance imaging. So, introduction, we see that spinal dystrophysm includes a highly heterogeneous group of congenital abnormalities that occur from abnormal closure of the neural tube, total identity at all, proposed a simple classification of spinal dystrophysm. Look, which was based on clinical findings and MRI findings. The closed form of spinal dystrophysm may be asymptomatic, but the open form is usually associated with several disabilities. Myelomeningocene is seen to be the most common type of open spinal dystrophysm and occurs from failed closure of the cordial end of the neural tube. There has been a significant worldwide decrease in the number of infants born with myelomeningocene because of improved maternal nutrition along with prenatal diagnostic tests and real time ultrasoundography. However, in those infants being born, depending on the location of the defect, significant neurological deficits might occur and patients have been found to suffer from lower limb paralysis, sensory loss along with bladder and bowel dysfunction. Myelomeningocene has been associated with multiple cerebral defects and these are directly related to intellectual and cognitive functioning. For example, hydrocephalus has been proposed to be the main cause of any cognitive dysfunction that the infant is suffering from. In addition, Wink et al had suggested that several other cognitive deficits might be attributed to Arnold-Carry malformation, which is seen in cases of myelomeningocene. There are few studies describing the forebred abnormalities related to myelomeningocene. However, most of these reports are based on autopsy studies, which might be suffering from selection bias towards severe types of malformation. We have evaluated cerebral abnormalities in patients with myelomeningocene, which the study done in children under six months of age in our present study. Our aim was to study and our aim of the study was to evaluate the pediatric brain in infants with myelomeningocene and determine the prevalence of various types of cerebral abnormalities in such cases. The materials and methods we used in the study were the study area was the department of radiative diagnosis in our hospital. The study period was from June 2020 to August 2021 and the study population consisted of 22 patients. The inclusion criteria was the patients referred to the radiative diagnosis department with myelomeningocene for the evaluation of their brain and the exclusion criteria where patients whose gargions did not give consent were excluded from the study. In addition, materials used where the brain MRI was performed with the 1.5 tesla G-signal, HD MRI standard, the patients underwent T1 weighted, T2 weighted filler and EDWI sequences in actual societal and coronal planes. The diagnostic criteria before we go into the depth of the study, the cari malformation are a group of defects with congenital cordal displacement, one of which is cari type 2, which is defined as a displacement of medulla or fourth ventricle and cerebellar formus into the cervical spinal canal and the presence of a small posterior fossa. Cerebellar hypoplasia was diagnosed when one or both cerebellar hemispheres were small with short but normally arranged fissures without any displacement through the foreman magnum. Brainstem hypoplasia was diagnosed when the brainstem had reduced societal dimensions and the anterior curvature of the points was flattened. Small posterior fossa was diagnosed when the posterior fossa had reduced societal dimensions to the corresponding deeply inclined interior. The partial agenesis of the corpus callosum was defined as an absence of a part of the corpus callosum, whereas corpus callosum dysplasia was applied when the morphology of the corpus callosum is altered. Corpus callosum was a descriptive term for the disproportionate prominence of the occipital horns of the lateral ventricle. In the results and analysis, the study consisted of 22 infants out of which 15 were male and 7 were female, the mean age was 2.5 months. Amongst the supratentrial findings, hydrocephalus was the predominant finding and it was seen in 16 patients. The enlargement of subarachnoid spaces was observed in 4 patients. Total agenesis of the corpus callosum was observed in 3 patients and all of whom had corpus callosum. Partial agenesis was observed in 4 patients and dysplasia of the corpus callosum was seen in 7 patients. A common finding was the presence of white inter hemispheric fissure that was observed in 9 patients and 5 of them also had corpus callosum abnormalities at the same time. Corpus callosum was observed in 3 patients and 2 patients were found to have polymicrogyria. Heterotopic grey matter was observed in 2 other patients and absence of septum pellucidum was observed in 3 patients. In the infratentrial findings, chai type 2 was observed in 15 patients and hyperplasia of the cerebellum was observed in 2 patients. Whereas hyperplasia of the brain stem was observed in 5 patients, a small posterior fossa was seen in a significant number that is 13 patients and cervical syrinx was seen in 1 patient. Now, discussion, myelomaningocele was seen to be associated with multiple cerebral defects as seen in our study. Mostly, however, in previous studies it was mostly done on autopsies based on autopsies. However, with the utilization of MRI, only some studies have attempted to evaluate patients of all age groups with myelomaningocele in our present study. After complete evaluation of cerebral abnormalities in children under 6 months of age, we found a spectrum of cerebral findings. Hydrocephalus was the most common finding as seen in also previous studies like just it all had reported that in a case series of 44 patients having myelomaningocele, hydrocephalus was detected in 27 patients. Now the enlargement of the lateral ventricle might be varied as a result of this symmetric and asymmetric dilatation can be observed. We could detect calligraphy in 13.6% of our patients. Anomalies of neural and migration usually causing seizures and developmental retardation have been reported in association with myelomaningocele. Just at all had described this abnormality in 6 out of 44 patients. In the present study, modules of heterotopic gray matter were seen in 2 patients. Now, interestingly, Hassan et al recently studied white matter microstructural abnormalities in children with myelomaningocele by using diffusion traction tensor tractography and found abnormal white matter development and persistent degeneration with increased age relative to control patients. Juronic at all studied using total cerebral volumes, neocortical surface area, neocortical thickness in children with myelomaningocele and subsequently reported about 15% reduction in total white matter and 69% increase in cerebral spinal fluid, but with no difference in total gray matter relative to the control group. Additionally, it was found that there can be significantly smaller neocortical surface area mainly in the occipital regions. Now polymicrogyria, which is very epileptic, has been reported to occur in 33% of patients with myelomaningocele. In our study, we could find it in only 2 patients. Now absence of septum pellucidum is also highly reported abnormality. It usually occurs along with abnormalities of the corpus callosum. In our study, there were 3 patients with absence of septum pellucidum. Out of these 2 were found to have concurrent partial agenesis of the corpus callosum. Now total or partial agenesis of the corpus callosum is seen to be a common finding as well. Just it all had recorded a frequency of 56% of partial agenesis of corpus callosum. Whereas Kaumira had observed partial agenesis in 50% of infants. Concerning infertorial abnormalities, the best known and the best documented in patients with myelomaningocele is obviously chiral malformation type 2. Just at all had found chiral malformation in 76% of patients. In our series, we observed chiral type 2 malformation in 68.2% of our patients. Therefore, the presentation of symptomatic chiral may vary depending on the child's age. Now decontration must be performed early for symptomatic chiral type 2 in order to promote a prompt and full neurological recovery. In 59.1% of our patients, this was found that a spinal posterior fossa was present. Brain, stomach, cerebellar, hypoplasia were other common findings and these can result in patients' neurological deterioration. One patient in our study was observed with cervical syringe. Just at all had reported that syringe occurred in all sections of the spinal cord and the size was seen to vary from small circumscribed cavities to large lesions. So apart from our study, we could see that apart from MRI, completed tomography and ultrasonography have also been used as alternative imaging techniques in the previous studies. Nevertheless, complete tomography has the distinct disadvantage of radiation exposure and ultrasonography is limited in the evaluation of posterior fossa. With lower resolution and operator dependence being a very vital factor in ultrasonography. So with taking all this into consideration, MRI is definitely the imaging procedure of choice. Limitations of our present study were mainly two things. First, we did not perform any volumetric measurements that would provide a more accurate characterization of our findings. And secondly, the study focused on structural findings of brain MRI and not the ultimate predicted neurological outcome, which needed follow-up of the patients. Here is a table number one, which shows MRI abnormalities detected in supratentorial compartment where we could see that the most common finding is obviously hydrocephalus seen in 16 patients. Here is table number two, which shows the MRI brain abnormalities detected in the intratentorial compartment where the most common findings were Kareem alformation type 2 seen in 15 patients. Here are some of the images of the findings seen in our study. This is figure one, which shows an actual T1 and T2 weighted MRI of two different infants showing hydrocephalus. This is figure two, which shows an actual T1 weighted image of an infant showing absent septum pelucidum. This is figure three, an actual T2 weighted image of an infant showing enlargement of the subarachnoid spaces as seen in this image. In figure number four, we see a sagittal T1 weighted image of an infant showing complete agenesis of the corpus callosum. There is no corpus callosum seen in this mid sagittal section. And in figure number five, an actual T1 weighted image of an infant showing nodular periventricular gray matter heterotopia and left lateral ventricle. In figure number six, there is a sagittal T1 weighted image of an infant showing cerebellar hypoplasia where the cerebellum is grossly reduced in size. And figure number seven shows a sagittal T1 weighted image of an infant showing partial agenesis of the corpus callosum with RNA type 2 malformation seen in the posterior fossa. Now in conclusion, we can say that brain imaging, especially with MRI at an early age, may be able to detect and characterize these abnormalities which are found to be associated with myelomeningosome. And detection of these abnormalities with proven neurocognitive effects will help to better determine the ultimate prognosis of the infant. These are my references. Thank you.