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Davutoglu EA, Arica G, Sahin NE, Ucar AK, Adaletli I, Vural ZM, Madazli R. Clinical characteristics and perinatal outcome of fetuses with ventriculomegaly. Arch Gynecol Obstet 2024:10.1007/s00404-024-07599-8. [PMID: 38926203 DOI: 10.1007/s00404-024-07599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To assess the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections, and perinatal outcomes of fetuses with ventriculomegaly (VM), also to evaluate the role of fetal magnetic resonance imaging (MRI) in detecting associated intracranial anomalies. METHODS Retrospective cohort study of 149 prenatally diagnosed pregnancies with fetal VM. VM was classified as mild (Vp = 10-12 mm), moderate (Vp = 12.1-15 mm), and severe (Vp > 15 mm). Fetal MRI was performed to 97 pregnancies. RESULTS The incidences of an associated CNS, non-CNS, chromosomal anomaly, genetic abnormality and fetal infection were 42.3%, 11.4%, 6.1%, 2.1% and 1.3%, respectively. Fetal MRI identified additional CNS anomalies in 6.7% of cases, particularly in severe VM. The incidences of perinatal outcomes were 18.8% termination of pregnancy, 4% intrauterine and 8.1% neonatal or infant death. The rates of fetuses alive at > 12 months of age with neurological morbidity were 2.6%, 11.1% and 76.9% for mild, moderate and severe isolated VM, respectively. CONCLUSION The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. Mild to moderate isolated VM generally have favorable outcomes. Fetal MRI is particularly valuable in fetuses with isolated severe VM.
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Affiliation(s)
- Ebru Alici Davutoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey
| | - Gorkem Arica
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey
| | - Nazli Ece Sahin
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Department of Pediatric Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Pediatric Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zekeriyya Mehmet Vural
- Department of Neonatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Riza Madazli
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
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Spruijt MS, van Klink JMM, de Vries LS, Slaghekke F, Middeldorp JM, Lopriore E, Tan RNGB, Toirkens JP, Steggerda SJ. Fetal and neonatal neuroimaging in twin-twin transfusion syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:746-757. [PMID: 38214436 DOI: 10.1002/uog.27583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/17/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To describe the types of brain injury and subsequent neurodevelopmental outcome in fetuses and neonates from pregnancies with twin-twin transfusion syndrome (TTTS). Additionally, to determine risk factors for brain injury and to review the use of neuroimaging modalities in these cases. METHODS This was a retrospective cohort study of consecutive TTTS pregnancies treated with laser surgery in a single fetal therapy center between January 2010 and January 2020. The primary outcome was the incidence of brain injury, classified into predefined groups. Secondary outcomes included adverse outcome (perinatal mortality or neurodevelopmental impairment), risk factors for brain injury and the number of magnetic resonance imaging (MRI) scans. RESULTS Cranial ultrasound was performed in all 466 TTTS pregnancies and in 685/749 (91%) liveborn neonates. MRI was performed in 3% of pregnancies and 4% of neonates. Brain injury was diagnosed in 16/935 (2%) fetuses and 37/685 (5%) neonates and all predefined injury groups were represented. Four fetal and four neonatal cases of cerebellar hemorrhage were detected. Among those with brain injury, perinatal mortality occurred in 11/16 (69%) fetuses and 8/37 (22%) neonates. Follow-up was available for 29/34 (85%) long-term survivors with brain injury and the mean age at follow-up was 46 months. Neurodevelopmental impairment was present in 9/29 (31%) survivors with brain injury. Adverse outcome occurred in 28/53 (53%) TTTS individuals with brain injury. The risk of brain injury was increased after recurrent TTTS/post-laser twin anemia-polycythemia sequence (TAPS) (odds ratio (OR), 3.095 (95% CI, 1.581-6.059); P = 0.001) and lower gestational age at birth (OR per 1-week decrease in gestational age, 1.381 (95% CI, 1.238-1.541); P < 0.001). CONCLUSIONS Based on dedicated neurosonography and limited use of MRI, brain injury was diagnosed in 2% of fetuses and 5% of neonates with TTTS. Adverse outcome was seen in over half of cases with brain injury. Brain injury was related to recurrent TTTS/post-laser TAPS and a lower gestational age at birth. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M S Spruijt
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatrics, Division of Perinatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M M van Klink
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - L S de Vries
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Slaghekke
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - J M Middeldorp
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - E Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R N G B Tan
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J P Toirkens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - S J Steggerda
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Yue F, Yang X, Liu N, Liu R, Zhang H. Prenatal diagnosis and pregnancy outcomes in fetuses with ventriculomegaly. Front Med (Lausanne) 2024; 11:1349171. [PMID: 38784233 PMCID: PMC11111914 DOI: 10.3389/fmed.2024.1349171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Genetic etiology plays a critical role in fetal ventriculomegaly (VM). However, the studies on chromosomal copy number variants (CNVs) in fetal VM are limited. This study aimed to investigate the chromosomal CNVs in fetuses with mild to moderate VM, and explore its genotype-phenotype correlation. Methods A total of 242 fetuses with mild to moderate VM detected by prenatal ultrasound were enrolled in our study from October 2018 to October 2022. All cases underwent chromosomal microarray analysis (CMA) and G-banding simultaneously. All VM cases were classified different subgroups according to the maternal age, severity, VM distribution and presence/absence of other ultrasound abnormalities. The pregnancy outcomes and health conditions after birth were followed up. We also performed a pooled analysis regarding likely pathogenic and pathogenic CNVs (LP/P CNVs) for VM. Results The detection rate of chromosomal abnormalities by karyotyping was 9.1% (22/242), whereas it was 16.5% (40/242) when CMA was conducted (P < 0.05). The total detection rate of chromosomal abnormalities by karyotyping and CMA was 21.1% (51/242). A 12.0% incremental yield of CMA over karyotyping was observed. The detection rate of total genetic variants in fetuses with bilateral VM was significantly higher than in fetuses with unilateral VM (30.0% vs. 16.7%, P = 0.017). No significant differences were discovered between isolated VM and non-isolated VM, or between mild and moderate VM, or between advanced maternal age (AMA) and non-AMA (all P > 0.05). 28 fetuses with VM were terminated and 214 fetuses were delivered: one presented developmental delay and one presented congenital heart disease. The VM cases with both positive CMA and karyotypic results had a higher rate of termination of pregnancy than those with either a positive CMA or karyotypic result, or both negative testing results (P < 0.001). Conclusion The combination of CMA and karyotyping should be adopted to improve the positive detection rate of chromosomal abnormalities for VM. The total genetic abnormalities detected using both techniques would affect the final pregnancy outcomes. LP/P CNVs at 16p11.2, 17p13, and 22q11.21 were identified as the top three chromosomal hotspots associated with VM, which would enable genetic counselors to provide more precise genetic counseling for VM pregnancies.
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Affiliation(s)
- Fagui Yue
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Xiao Yang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Ning Liu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Ruizhi Liu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Hongguo Zhang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
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Zhao X, Li X, Yu M, Jia JA, Tian R, Zhu F. Genotype-phenotype correlation study of structural abnormalities in a fetal brain caused by a novel KDM4B variant. Mol Biol Rep 2024; 51:188. [PMID: 38270710 DOI: 10.1007/s11033-023-09092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Fetal ventriculomegaly (VM), a common brain structure malformation detected during prenatal ultrasound diagnosis, is associated with an increased risk of neurodevelopmental disorders (NDDs) after birth. KDM4B encodes a lysine-specific demethylase that interacts with histone H3K23me3. Variations in KDM4B are reportedly associated with human NDDs; however, only 11 such patients have been reported. Herein, we report a fetus with VM and agenesis of the corpus callosum (ACC), which suggests that KDM4B plays an important role in fetal brain development. METHODS Fetal skin tissue and parental peripheral venous blood samples were collected. Whole-exome and Sanger sequencing were performed to analyze fetal germline variants. Human 293T cells transfected with wild-type or mutant KDM4B were used for western blotting (WB) to analyze protein expression levels. RESULTS An insertion variant of KDM4B, NM_015015.3: c.2889_2890insGAGAGCATCACGGTGAGCTGTGGGGTGGGGCAGGGGGCGGGGGGAGGCTGGGAGCACAGTGACAACCTGTACCCC, was identified in the fetal tissue; however, the parents carried the wild-type gene. The WB results indicated significantly reduced expression of the mutant protein, likely owing to decreased stability. CONCLUSIONS The structural abnormalities in the brain of the studied fetus may be attributed to an insertion variant of KDM4B. This study highlights the importance of screening for KDM4B variants and considering potential copy number variations when observing VM or ACC in prenatal ultrasound imaging.
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Affiliation(s)
- Xuliang Zhao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
- Department of Laboratory, The 901th Hospital of the Joint Service of the People's Liberation Army, Hefei, China
| | - Xu Li
- Department of Radiology, Anhui Children's Hospital, Hefei, China
| | - Min Yu
- Department of Obstetrics and Gynecology, The 901th Hospital of the Joint Service of the People's Liberation Army, Hefei, 230031, China
| | - Jian-An Jia
- Department of Laboratory, The 901th Hospital of the Joint Service of the People's Liberation Army, Hefei, China
| | - Ruixia Tian
- Department of Obstetrics and Gynecology, The 901th Hospital of the Joint Service of the People's Liberation Army, Hefei, 230031, China.
| | - Fuxi Zhu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.
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Peralta CFA, Medrado AP, Botelho RD, Jorge Rodrigues da Costa K, Imada V, Lamis F. Percutaneous fetal endoscopic third ventriculostomy for severe isolated cerebral ventriculomegaly. Prenat Diagn 2023; 43:1614-1621. [PMID: 37940634 DOI: 10.1002/pd.6465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To demonstrate the feasibility and preliminary results of percutaneous fetal endoscopic third ventriculostomy (ETV) in human fetuses (pfETV) with isolated progressive and/or severe bilateral cerebral ventriculomegaly (IPSBV). METHODS The initial results of pfETV for IPSBV were described. Perioperative, perinatal and postnatal variables were described. The Ages and Stages Questionnaire (ASQ-3), 3rd edition (ASQ-3) was used for follow-up of all infants. RESULTS Successful pfETV was performed in 10/11 (91%) fetuses, at a median gestational age (GA) of 28.7 weeks (25.3-30.7). There were no perioperative complications. After pfETV, 70% (7/10) of the fetuses had a decreased or stabilized lateral ventricle atria|lateral ventricle's atria. The median GA at delivery was 38.2 weeks (35.9-39.3). There were no perinatal complications. The postnatal ventriculoperitoneal shunt rate was 80% (8/10). Among neonates/infants who had prenatal stabilization or a decrease in the LVAs, 4 (4/7: 57.1%) had abnormal scores on the ASQ-3. Among neonates/infants that experienced prenatal increases in the LVAs, all of them (3/3: 100%) had abnormal scores on the ASQ-3. CONCLUSION Percutaneous ETV is feasible in human fetuses with progressive and/or severe cerebral ventriculomegaly and seems to be a safe procedure for both the mother and the fetus.
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Affiliation(s)
- Cleisson Fábio Andrioli Peralta
- Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil
- Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil
- Fetal Medicine Unit, CETRUS - São Paulo Ultrasound Training Center, São Paulo, Brazil
| | - Aletea Patrícia Medrado
- Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil
- Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil
- Fetal Medicine Unit, CETRUS - São Paulo Ultrasound Training Center, São Paulo, Brazil
| | - Rafael Davi Botelho
- Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil
- Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil
| | - Karina Jorge Rodrigues da Costa
- Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil
- Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil
| | - Vanessa Imada
- Department of Neurosurgery, HCor Hospital do Coração, São Paulo, Brazil
| | - Fabricio Lamis
- Department of Neurosurgery, HCor Hospital do Coração, São Paulo, Brazil
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Yousefpour Shahrivar R, Karami F, Karami E. Enhancing Fetal Anomaly Detection in Ultrasonography Images: A Review of Machine Learning-Based Approaches. Biomimetics (Basel) 2023; 8:519. [PMID: 37999160 PMCID: PMC10669151 DOI: 10.3390/biomimetics8070519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Fetal development is a critical phase in prenatal care, demanding the timely identification of anomalies in ultrasound images to safeguard the well-being of both the unborn child and the mother. Medical imaging has played a pivotal role in detecting fetal abnormalities and malformations. However, despite significant advances in ultrasound technology, the accurate identification of irregularities in prenatal images continues to pose considerable challenges, often necessitating substantial time and expertise from medical professionals. In this review, we go through recent developments in machine learning (ML) methods applied to fetal ultrasound images. Specifically, we focus on a range of ML algorithms employed in the context of fetal ultrasound, encompassing tasks such as image classification, object recognition, and segmentation. We highlight how these innovative approaches can enhance ultrasound-based fetal anomaly detection and provide insights for future research and clinical implementations. Furthermore, we emphasize the need for further research in this domain where future investigations can contribute to more effective ultrasound-based fetal anomaly detection.
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Affiliation(s)
- Ramin Yousefpour Shahrivar
- Department of Biology, College of Convergent Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, 14515-775, Iran
| | - Fatemeh Karami
- Department of Medical Genetics, Applied Biophotonics Research Center, Science and Research Branch, Islamic Azad University, Tehran, 14515-775, Iran
| | - Ebrahim Karami
- Department of Engineering and Applied Sciences, Memorial University of Newfoundland, St. John’s, NL A1B 3X5, Canada
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She J, Huang H, Ye Z, Huang W, Sun Y, Liu C, Yang W, Wang J, Ye P, Zhang L, Ning G. Automatic biometry of fetal brain MRIs using deep and machine learning techniques. Sci Rep 2023; 13:17860. [PMID: 37857681 PMCID: PMC10587162 DOI: 10.1038/s41598-023-43867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Linear biometric measurements on magnetic resonance images are important for the assessment of fetal brain development, which is expert knowledge dependent and laborious. This study aims to construct a segmentation-based method for automatic two-dimensional biometric measurements of fetal brain on magnetic resonance images that provides a fast and accurate measurement of fetal brain. A total of 268 volumes (5360 images) magnetic resonance images of normal fetuses were included. The automatic method involves two steps. First, the fetal brain was segmented into four parts with a deep segmentation network: cerebrum, cerebellum, and left and right lateral ventricles. Second, the measurement plane was determined, and the corresponding biometric parameters were calculated according to clinical guidelines, including cerebral biparietal diameter (CBPD), transverse cerebellar diameter (TCD), left and right atrial diameter (LAD/RAD). Pearson correlation coefficient and Bland-Altman plots were used to assess the correlation and agreement between computer-predicted values and manual measurements. Mean differences were used to evaluate the errors quantitatively. Analysis of fetal cerebral growth based on the automatic measurements was also displayed. The experiment results show that correlation coefficients for CBPD, TCD, LAD and RAD were as follows: 0.977, 0.990, 0.817, 0.719, mean differences were - 2.405 mm, - 0.008 mm, - 0.33 mm, - 0.213 mm, respectively. The correlation between the errors and gestational age was not statistically significant (p values were 0.2595, 0.0510, 0.1995, and 0.0609, respectively). The proposed automatic method for linear measurements on fetal brain MRI achieves excellent performance, which is expected to be applied in clinical practice and be helpful for prenatal diagnosis and clinical work efficiency improvement.
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Affiliation(s)
- Jiayan She
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Haiying Huang
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Zhijun Ye
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Huang
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Yan Sun
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Chuan Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Weilin Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiaxi Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Pengfei Ye
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Lei Zhang
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Gang Ning
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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Tao H, Zhang L, Tan F, Han Y, Wang X, Wu J, Zhai J. Pregnancy outcomes and genetic analysis for fetal ventriculomegaly. Front Genet 2023; 14:1186660. [PMID: 37795247 PMCID: PMC10545856 DOI: 10.3389/fgene.2023.1186660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction: Fetal ventriculomegaly (VM) is associated with neurodevelopmental disorders, partly caused by genetic factor. Methods: To systematically investigate the genetic etiology of fetal VM and related pregnancy outcomes in different subgroups: IVM (isolated VM) and NIVM (non-isolated VM); unilateral and bilateral VM; mild, moderate, and severe VM, a retrospective study including 131 fetuses with VM was carried out from April 2017 to August 2022. Results: 82 cases underwent amniocentesis or cordocentesis, of whom 8 cases (9.8%) were found chromosomal abnormalities by karyotyping. Meanwhile, additional 8 cases (15.7%) with copy number variations (CNVs) were detected by copy number variation sequencing (CNV-seq). The detection rate (DR) of chromosomal abnormalities was higher in NIVM, bilateral VM and severe VM groups. And CNVs frequently occurred in NIVM, bilateral VM and moderate VM groups. In the NIVM group, the incidence of chromosomal aberrations and CNVs in multiple system anomalies (19.0%, 35.7%) was higher than that in single system anomalies (10.0%, 21.1%). After dynamic ultrasound follow-up, 124 cases were available in our cohort. 12 cases were further found other structural abnormalities, and lateral ventricular width was found increased in 8 cases and decreased in 15 cases. Meanwhile, 82 cases underwent fetal brain MRI, 10 cases of brain lesions and 11 cases of progression were additionally identified. With the involvement of a multidisciplinary team, 45 cases opted for termination of pregnancy (TOP) and 79 cases were delivered with live births. One infant death and one with developmental retardation were finally found during postnatal follow-ups. Discussion: CNV-seq combined with karyotyping could effectively improve the diagnostic rate in fetuses with VM. Meanwhile, dynamic ultrasound screening and multidisciplinary evaluation are also essential for assessing the possible outcomes of fetuses with VM.
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Affiliation(s)
- Huimin Tao
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
| | - Lin Zhang
- School of Information and Control Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Fangfang Tan
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
| | - Yu Han
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
| | - Xuezhen Wang
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
| | - Jiebin Wu
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
| | - Jingfang Zhai
- Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Brain Diseases Bioinformation of Xuzhou Medical University, Xuzhou, China
- Department of Prenatal Diagnosis Medical Center, Xuzhou Central Hospital, Xuzhou, China
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Mustafa HJ, Sambatur EV, Barbera JP, Pagani G, Yaron Y, Baptiste CD, Wapner RJ, Khalil A. Diagnostic yield with exome sequencing in prenatal severe bilateral ventriculomegaly: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101048. [PMID: 37311485 DOI: 10.1016/j.ajogmf.2023.101048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to determine the incremental diagnostic yield of prenatal exome sequencing after negative chromosomal microarray analysis results in prenatally diagnosed bilateral severe ventriculomegaly or hydrocephalus; another objective was to categorize the associated genes and variants. DATA SOURCES A systematic search was performed to identify relevant studies published until June 2022 using 4 databases (Cochrane Library, Web of Science, Scopus, and MEDLINE). STUDY ELIGIBILITY CRITERIA Studies in English reporting on the diagnostic yield of exome sequencing following negative chromosomal microarray analysis results in cases of prenatally diagnosed bilateral severe ventriculomegaly were included. METHODS Authors of cohort studies were contacted for individual participant data, and 2 studies provided their extended cohort data. The incremental diagnostic yield of exome sequencing was assessed for pathogenic/likely pathogenic findings in cases of: (1) all severe ventriculomegaly; (2) isolated severe ventriculomegaly (as the only cranial anomaly); (3) severe ventriculomegaly with other cranial anomalies; and (4) nonisolated severe ventriculomegaly (with extracranial anomalies). To be able to identify all reported genetic associations, the systematic review portion was not limited to any minimal severe ventriculomegaly case numbers; however, for the synthetic meta-analysis, we included studies with ≥3 severe ventriculomegaly cases. Meta-analysis of proportions was done using a random-effects model. Quality assessment of the included studies was performed using the modified STARD (Standards for Reporting of Diagnostic Accuracy Studies) criteria. RESULTS A total of 28 studies had 1988 prenatal exome sequencing analyses performed following negative chromosomal microarray analysis results for various prenatal phenotypes; this included 138 cases with prenatal bilateral severe ventriculomegaly. We categorized 59 genetic variants in 47 genes associated with prenatal severe ventriculomegaly along with their full phenotypic description. There were 13 studies reporting on ≥3 severe ventriculomegaly cases, encompassing 117 severe ventriculomegaly cases that were included in the synthetic analysis. Of all the included cases, 45% (95% confidence interval, 30-60) had positive pathogenic/likely pathogenic exome sequencing results. The highest yield was for nonisolated cases (presence of extracranial anomalies; 54%; 95% confidence interval, 38-69), followed by severe ventriculomegaly with other cranial anomalies (38%; 95% confidence interval, 22-57) and isolated severe ventriculomegaly (35%; 95% confidence interval, 18-58). CONCLUSION There is an apparent incremental diagnostic yield of prenatal exome sequencing following negative chromosomal microarray analysis results in bilateral severe ventriculomegaly. Although the greatest yield was found in cases of nonisolated severe ventriculomegaly, consideration should also be given to performing exome sequencing in cases of isolated severe ventriculomegaly as the only brain anomaly identified on prenatal imaging.
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Affiliation(s)
- Hiba J Mustafa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN (Dr Mustafa); Fetal Center at Riley Children's Health, Indiana University Health, Indianapolis, IN (Dr Mustafa).
| | - Enaja V Sambatur
- Research Division, Houston Center for Maternal Fetal Medicine, Houston, TX (Ms Sambatur)
| | - Julie P Barbera
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Ms Barbera)
| | - Giorgio Pagani
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy (Dr Pagani)
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Yaron); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Yaron)
| | - Caitlin D Baptiste
- Division of Women's Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Baptiste and Wapner)
| | - Ronald J Wapner
- Division of Women's Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Baptiste and Wapner)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom (Dr Khalil); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom (Dr Khalil)
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10
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Vasconcelos Miranda TA, Tsuchiya K, Lucato LT. Imaging of Central Nervous System Parasitic Infections. Neuroimaging Clin N Am 2023; 33:125-146. [DOI: 10.1016/j.nic.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Giorgione V, Haratz KK, Constantini S, Birnbaum R, Malinger G. Fetal cerebral ventriculomegaly: What do we tell the prospective parents? Prenat Diagn 2022; 42:1674-1681. [PMID: 36371614 PMCID: PMC10099769 DOI: 10.1002/pd.6266] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/16/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
Fetal cerebral ventriculomegaly is a relatively common finding, observed during approximately 1% of obstetric ultrasounds. In the second and third trimester, mild (≥10 mm) and severe ventriculomegaly (≥15 mm) are defined according to the measurement of distal lateral ventricles that is included in the routine sonographic examination of central nervous system. A detailed neurosonography and anatomy ultrasound should be performed to detect other associated anomalies in the central nervous system and in other systems, respectively. Fetal MRI might be useful when neurosonography is unavailable or suboptimal. The risk of chromosomal and non-chromosomal genetic disorders associated with ventriculomegaly is high, therefore invasive genetic testing, including microarray, is recommended. Screening for prenatal infections, in particular cytomegalovirus and toxoplasmosis, should also be carried out at diagnosis. The prognosis is determined by the severity of ventriculomegaly and/or by the presence of co-existing abnormalities. Fetal ventriculoamniotic shunting in progressive isolated severe ventriculomegaly is an experimental procedure. After delivery, ventricular-peritoneal shunting or ventriculostomy are the two available options to treat hydrocephalus in specific conditions with similar long-term outcomes. A multidisciplinary fetal neurology team, including perinatologists, geneticists, pediatric neurologists, neuroradiologists and neurosurgeons, can provide parents with the most thorough prenatal counseling. This review outlines the latest evidence on diagnosis and management of pregnancies complicated by fetal cerebral ventriculomegaly.
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Affiliation(s)
- Veronica Giorgione
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Karina Krajden Haratz
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roee Birnbaum
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gustavo Malinger
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Ryan GA, Start AO, Cathcart B, Hughes H, Denona B, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Robinson I, Colleran G, McParland P, McAuliffe FM. Prenatal findings and associated survival rates in fetal ventriculomegaly: A prospective observational study. Int J Gynaecol Obstet 2022; 159:891-897. [PMID: 35373343 PMCID: PMC9790218 DOI: 10.1002/ijgo.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Fetal ventriculomegaly is associated with varying degrees of genetic and structural abnormalities. The objective was to present the experience of fetal ventriculomegaly in a large European center in relation to: 1. grade of ventriculomegaly; 2. additional chromosomal/structural abnormalities; and 3. perinatal survival rates. METHODS This was a prospective observational study of patients referred with fetal ventriculomegaly from January 2011 to July 2020. Data were obtained from the hospital database and analyzed to determine the rate of isolated ventriculomegaly, associated structural abnormalities, chromosomal/genetic abnormalities, and survival rates. Data were stratified into three groups; mild (Vp = 10-12 mm), moderate (Vp = 13-15 mm) and severe (Vp > 15 mm) ventriculomegaly. RESULTS There were 213 fetuses included for analysis. Of these 42.7% had mild ventriculomegaly, 44.6% severe and 12.7% had moderate ventriculomegaly. Initial ultrasound assessment reported isolated ventriculomegaly in 45.5% fetuses, with additional structural abnormalities in 54.5%. The rate of chromosomal/genetic abnormalities was high,16.4%. After all investigations, the true rate of isolated VM was 36.1%. The overall survival was 85.6%. Survival was higher for those with isolated VM across all groups (P < 0.05). CONCLUSION Ventriculomegaly is a complex condition and patients should be counselled that even with apparently isolated VM, there remains the possibility of additional genetic and/or structural problems being diagnosed in up to 10% of fetuses.
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Affiliation(s)
- Gillian A. Ryan
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Alexander O. Start
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Barbara Cathcart
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Heather Hughes
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | | | - Shane Higgins
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Siobhan Corcoran
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Jennifer Walsh
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Stephen Carroll
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Rhona Mahony
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Darach Crimmins
- Neurosurgery DepartmentChildren's University HospitalDublinIreland,UCD School of MedicineUniversity College DublinIreland
| | - John Caird
- Neurosurgery DepartmentChildren's University HospitalDublinIreland
| | - Ian Robinson
- Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Gabrielle Colleran
- UCD School of MedicineUniversity College DublinIreland,Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Peter McParland
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
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13
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Mangla M, Anne RP. Perinatal management of pregnancies with Fetal Congenital Anomalies: A guide to Obstetricians and Pediatricians. Curr Pediatr Rev 2022; 20:CPR-EPUB-126790. [PMID: 36200158 DOI: 10.2174/1573396318666221005142001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/14/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022]
Abstract
Background Congenital anomalies are responsible for approximately 20% of all neonatal deaths worldwide. Improvements in antenatal screening and diagnosis have significantly improved the prenatal detection of birth defects; however, these improvements have not translated into the improved neonatal prognosis of babies born with congenital anomalies. Objectives An attempt has been made to summarise the prenatal interventions, if available, the optimal route, mode and time of delivery and discuss the minimum delivery room preparations that should be made if expecting to deliver a fetus with a congenital anomaly. Methods The recent literature related to the perinatal management of the fetus with prenatally detected common congenital anomalies were searched in English peer-reviewed journals from the PubMed database, to work out an evidence-based approach for their management. Results Fetuses with prenatally detected congenital anomalies should be delivered at a tertiary care centre with facilities for neonatal surgery and paediatric intensive care if needed. There is no indication for preterm delivery in the majority of cases. Only a few congenital malformations, like high-risk sacrococcygeal teratoma, congenital lung masses with significant fetal compromise, fetal cerebral lesions or neural tube defects with Head circumference >40 cm or the biparietal diameter is ≥12 cm, gastroschisis with extracorporeal liver, or giant omphaloceles in the fetus warrant caesarean section as the primary mode of delivery. Conclusion The prognosis of a fetus with congenital anomalies can be significantly improved if planning for delivery, including the Place and Time of delivery, is done optimally. A multi-disciplinary team should be available for the fetus to optimize conditions right from when it is born.
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Affiliation(s)
- Mishu Mangla
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Rajendra Prasad Anne
- Department of Pediatrics All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
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14
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Guimaraes CVA, Dahmoush HM. Fetal Brain Anatomy. Neuroimaging Clin N Am 2022; 32:663-681. [PMID: 35843668 DOI: 10.1016/j.nic.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
"Fetal brain development has been well studied, allowing for an ample knowledge of the normal changes that occur during gestation. Imaging modalities used to evaluate the fetal central nervous system (CNS) include ultrasound and MRI. MRI is the most accurate imaging modality for parenchymal evaluation and depiction of developmental CNS anomalies. The depiction of CNS abnormalities in a fetus can only be accurately made when there is an understanding of its normal development. This article reviews the expected normal fetal brain anatomy and development during gestation. Additional anatomic structures seen on brain imaging sequences are also reviewed."
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Affiliation(s)
- Carolina V A Guimaraes
- Division Chief of Pediatric Radiology, Department of Radiology, University of North Carolina, School of Medicine, 2006 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7510, USA.
| | - Hisham M Dahmoush
- Department of Radiology, Stanford School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94304, USA
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15
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Hernandez NE, Lu VM, Altman N, Ragheb J, Niazi TN, Wang S. Incidence, follow-up, and postnatal clinical progress of children with central nervous system anomalies on fetal MRI. J Neurosurg Pediatr 2022; 30:160-168. [PMID: 35901770 DOI: 10.3171/2022.4.peds2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI is increasingly employed to assess intrauterine fetal anomalies. Central nervous system (CNS) anomalies are common structural conditions that warrant evaluation with fetal MRI and subsequent prenatal consultation with a pediatric neurosurgeon. As the use of fetal MRI increases, there is greater impetus to understand the most common CNS structural anomalies diagnosed in utero, as well as their natural histories. METHODS The authors performed a single-center retrospective review of fetal MRI evaluations performed between January 2012 and December 2020. Children who underwent both prenatal and postnatal neurosurgical evaluations of CNS anomalies were included. Specific CNS anomalies on fetal MRI, associated extra-CNS findings, and suspicion for genetic abnormality or syndromes were noted. Postnatal clinical status and interventions were assessed. RESULTS Between January 2012 and December 2020, a total of 469 fetal MRI evaluations were performed; of these, 114 maternal-fetal pairs had CNS anomalies that warranted prenatal consultation and postnatal pediatric neurosurgical follow-up. This cohort included 67 male infants (59%), with a mean ± SD follow-up of 29.8 ± 25.0 months after birth. Fetal MRI was performed at 27.3 ± 5.8 weeks of gestational age. The most frequently reported CNS abnormalities were ventriculomegaly (57%), agenesis or thinning of the corpus callosum (33%), Dandy-Walker complex (DWC) (21%), neuronal migration disorders (18%), and abnormalities of the septum pellucidum (17%). Twenty-one children (18%) required neurosurgical intervention at a mean age of 2.4 ± 3.7 months. The most common surgical conditions included myelomeningocele, moderate to severe ventriculomegaly, encephalocele, and arachnoid cyst. Corpus callosum agenesis or thinning was associated with developmental delay (p = 0.02) and systemic anomalies (p = 0.05). The majority of prenatal patients referred for DWC had Dandy-Walker variants that did not require surgical intervention. CONCLUSIONS The most common conditions for prenatal neurosurgical assessment were ventriculomegaly, corpus callosum anomaly, and DWC, whereas the most common surgical conditions were myelomeningocele, hydrocephalus, and arachnoid cyst. Only 18% of prenatal neurosurgical consultations resulted in surgical intervention during infancy. The majority of referrals for prenatal mild ventriculomegaly and DWC were not associated with developmental or surgical sequelae. Patients with corpus callosum abnormalities should be concurrently referred to a neurologist for developmental assessments.
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Affiliation(s)
- Nicole E Hernandez
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
| | - Victor M Lu
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Nolan Altman
- 3Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | - John Ragheb
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Toba N Niazi
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Shelly Wang
- 1Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
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16
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Deopujari C, Mohanty C, Agrawal H, Jain S, Chawla P. A comparison of Adult and Pediatric Hydrocephalus. Neurol India 2022; 69:S395-S405. [PMID: 35102995 DOI: 10.4103/0028-3886.332283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hydrocephalus is a common clinical problem encountered in neurosurgical practice. With greater subspecialisation, pediatric neurosurgery has emerged as a special discipline in several countries. However, in the developing world, which inhabits a large pediatric population, a limited number of neurosurgeons manage all types of hydrocephalus across all ages. There are some essential differences in pediatric and adult hydrocephalus. The spectrum of hydrocephalus of dysgenetic origin in a neonate and that of normal pressure hydrocephalus of the old age has a completely different strategy of management. Endoscopic third ventriculostomy outcomes are known to be closely associated with age at presentation and surgery. Efficacy of alternative pathways of CSF absorption also differs according to age. Managing this disease in various age groups is challenging because of these differences in etiopathology, tempo of the disease, modalities of investigations and various treatment protocols as well as prognosis.
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Affiliation(s)
- Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences; B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences; B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | | | - Sonal Jain
- B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Pawan Chawla
- B J Wadia Hospital for Children, Mumbai, Maharashtra, India
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17
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Start AO, Ryan GA, Cathcart B, Hughes H, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Colleran G, McParland P, McAuliffe FM. Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort. Prenat Diagn 2021; 42:109-117. [PMID: 34870870 DOI: 10.1002/pd.6072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/12/2021] [Accepted: 10/07/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Severe fetal ventriculomegaly (VM) is defined as an enlargement of the atria of the lateral cerebral ventricles (Vp) of greater than 15 mm. While it is well established that it confers significant risk of morbidity and mortality to the neonate, there is limited information pertaining to the caesarean delivery rates and the obstetric management of these complex cases. The aim of this study was twofold: firstly, to determine survival rates in fetuses with severe VM, and secondly to determine the caesarean delivery rates in continuing pregnancies. We explore the obstetric challenges associated with these difficult cases. METHODS This was a prospective observational study of patients with antenatal severe VM, attending the Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland, from 1st January 2011 to 31st July 2020. Data were obtained from the hospital database and those with severe VM (Vp > 15 mm) were identified. The rates of chromosomal abnormalities, the survival rates and the caesarean delivery (CD) rates for the overall group were then determined. The data were then further sub-divided into two groups: 1. Vp < 20 mm and 2. Vp > 20 mm, and the results compared. Statistical analysis was performed using the Chi-Square test. RESULTS A total of N = 95 pregnancies with severe VM were included for analysis, of which additional structural abnormalities on ultrasound were apparent in 67/95 (70.5%) and 28/95 (29.5%) had isolated severe VM. Chromosomal abnormalities were diagnosed in 15/95 (15.8%) of cases, with (2/28) 7.1% in the isolated SVM group versus (13/67) 19.4% in the non-isolated SVM group. The overall survival rate (excluding TOP) was 53/74 (71.6%), with 20/23 (86.9%) in the isolated SVM group. The overall CD rate was 47/72 (65.3%), which was significantly higher than the CD for the hospital during the same time period of 25.4% (P < 0.01). The data were subdivided into Vp < 20 and Vp > 20 and those with a Vp > 20 had higher rates of additional intracranial findings on ultrasound (Vp < 20 13/41 (31.7%) versus Vp > 20 32/54 (59.3%) (P < 0.05)) and macrocrania (Vp < 20 14/41 (34.1%) versus Vp > 20 35/54 (64.8%) (P < 0.05)). No significant difference was observed in the overall survival or CD rates between the two groups. CONCLUSION In conclusion this study reports significant fetal morbidity and mortality with severe VM with high CD rates observed in this cohort. Significant challenges exist in relation to the obstetric management and counseling of parents regarding an often uncertain neonatal prognosis. In continuing pregnancies with significant macrocrania delivery plans should be individualized to improve neonatal outcomes where possible and minimize harm to the mother.
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Affiliation(s)
- Alex O Start
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Gillian A Ryan
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Barbara Cathcart
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Heather Hughes
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Shane Higgins
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Siobhan Corcoran
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Jennifer Walsh
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Stephen Carroll
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Rhona Mahony
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Darach Crimmins
- Neurosurgery Department, Children's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - John Caird
- Neurosurgery Department, Children's University Hospital, Dublin, Ireland
| | - Gabrielle Colleran
- UCD School of Medicine, University College Dublin, Dublin, Ireland.,Radiology Department, The National Maternity Hospital, Dublin, Ireland
| | - Peter McParland
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
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