Fetal ventriculomegaly: prognosis in cases in which prenatal neurosurgical consultation was sought

Abstract

The authors conclude that delayed development and disturbed functional status in patients in whom FVM was diagnosed prenatally are closely related to the presence of certain accompanying anomalies. On postnatal examination, more than half of the patients in whom the diagnosis of FVM was based on ultrasonography findings and whose parents were offered prenatal neurosurgical consultation were found to have additional anomalies that were not detected prenatally. Because of the possibility of additional undiagnosed anomalies, consulting neurosurgeons should be cautious in giving a prognosis in cases of FVM, even when prenatal ultrasonography reveals isolated ventriculomegaly and tests for intrauterine infection and chromosomal abnormality yield negative results.

Natural history of apparently isolated severe fetal ventriculomegaly: perinatal survival and neurodevelopmental outcome

“…There are limitations as demonstrated by our MRI results to the prenatal assessment of isolated SVM. These findings are similar to previous reports where postnatal assessment revealed additional abnormalities in over half their population size (25/44), of which a minority were detected prenatally (3/25) (Lee et al, 2006). Agenesis of the corpus callosum and neuronal migration defects were the most common undiagnosed abnormalities.…”

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

“…In children with greater LVA width (≥ 15 mm), signs such as progressive increase in HC or bulging fontanels occur more frequently, which lead to the indication of VP shunts 18 . We emphasize that 6% of the children who required a VP shunt showed progressive increase in the ventricular system (identified using TUS) without an increase in HC or bulging fontanels, however showed signs suggestive of neurological impairment due to Chiari II malformation.…”

“…Based on previously established measurements, a neonate was considered as having mild hydrocephalus when the transversal lateral ventricular atrium (LVA) width, measured slightly above the level of the thalami at the level of the choroid plexus, was < 15 mm (10-14mm) 18 . When this value was ≥ 15 mm (15-19mm), the neonate was considered as having moderate hydrocephalus 18 .…”

“…When this value was ≥ 15 mm (15-19mm), the neonate was considered as having moderate hydrocephalus 18 . Thus, the study population was divided into two groups:…”

“…We consider the measure of HC and evaluation of the fontanels as the most important clinical signs to be observed in these children, according to previously published studies 11,15,16,17,19 . Infant girls with HC of 37.7 cm and infant boys with HC of 38.5 cm who showed an increase in the ventricular system were considered as having hydrocephalus since birth 17,18,20 . In this group, the proposal for treatment was of closure of MM and VP shunt at the same surgical time.…”