Ventriculo‐amniotic shunting for severe fetal ventriculomegaly

Abstract

Severe fetal cerebral ventriculomegaly, observed in about 1 in 1000 newborns, may result from chromosomal and genetic abnormalities, brain hemorrhage, or congenital infection, but in many cases there is no clear-cut etiology. The condition is associated with a high risk of perinatal death and neurodevelopmental delay in survivors and after prenatal diagnosis many parents choose to have pregnancy termination. However, some parents choose to continue with the pregnancy and in other cases the diagnosis is made at a gestational age at which termination is not a legal option. One option in the management of such cases of severe ventriculomegaly is intrauterine therapy by

Prenatal diagnosis of a nonsense mutation in the L1CAM gene resulting in congenital hydrocephalus: A case report and literature review

“…However, repeated shunting was required in nearly half of the cases and a high proportion of survivors have neurodevelopmental delay. It has been proposed that the possible beneficial role of ventriculo-amniotic shunting requires to be confirmed by randomized studies with a large sample size (32).…”

Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort

“…While there have been significant advances in the diagnoses of fetal malformations in recent years, the same improvements have not been seen in the surgical treatments for fetal ventriculomegaly. 19 Fetal surgical options, including cephalocentesis 17,18 and venticulo-amniotic shunts, 19,20 shunting. 23 Several reasons have been cited to explain the historic suboptimal outcomes and include poor patient selection and lower quality imaging modalities.…”

“…23,27,28 Ventriculo-amniotic shunting may improve neurologic outcomes in selected patients and decrease maternal morbidity at the time of delivery. 28 There is a need for further evaluation on the topic 20 and a research agenda has been constructed, and investigation is underway to determine in use in routine clinical practice. 20,28 Extended or classical CD procedures have also been considered…”

“…For those who continue the pregnancy, severe VM can progress and in turn cause significant macrocrania, which can result in increased maternal morbidity, as CD is more likely to be indicated secondary to an enlarging head circumference (HC). 13,16 Fetal surgical options including cephalocentesis 17,18 and fetal venticulo-amniotic shunts 19,20 have been reported to decompress the fetal head in order to facilitate delivery. However, their role in the management of this condition is controversial and at present antenatal procedures for ventriculomegaly are not accepted practice due to lack of evidence to support them.…”

“…However, their role in the management of this condition is controversial and at present antenatal procedures for ventriculomegaly are not accepted practice due to lack of evidence to support them. 17,20 With regards to optimal timing and mode of delivery there is limited data pertaining to mild and moderate VM and even less guidance to direct management in cases of severe VM. There is a paucity of data on the CD rates in this cohort.…”