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Guo D, He D, Shen Q, Lin N, He S, Dai Y, Li Y, Xu L, Wu X. Comprehensive Assessment of Fetal Bilateral Ventriculomegaly Based on Genetic Disorders, Cytomegalovirus Infection, Extra Prenatal Imaging and Pregnancy Outcomes in a Tertiary Referral Center. Int J Gen Med 2021; 14:7719-7728. [PMID: 34764685 PMCID: PMC8577530 DOI: 10.2147/ijgm.s335011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This retrospective study aimed to systematically evaluate the genetic disorders, cytomegalovirus (CMV) infection, extra ultrasound findings and outcomes of fetuses with bilateral ventriculomegaly (BVM). Methods Data from pregnancies with fetal BVM were obtained between 2014 and 2020. The cases were divided into groups of isolated bilateral ventriculomegaly (IBVM) and non-isolated bilateral ventriculomegaly (NIBVM) according to the presence of extra prenatal imaging. Subgroups of mild, moderate, and severe were determined according to lateral ventricle widths. The NIBVM group was further classified into pregnancies with soft markers, non-structural abnormalities, and structural abnormalities. Results A total of 353 pregnancies were enrolled, including 153 cases of IBVM and 200 cases of NIBVM. Conventional karyotyping was performed on 192 samples, and 15 cases of numerical abnormalities and 3 cases of unbalanced structural abnormalities were identified. Chromosomal microarray analysis (CMA) was concurrently performed on 108 of them and revealed additional 5 cases (4.7%) of copy number variants with clinical significance. CMV DNA testing was performed on 154 of the 192 cases that underwent invasive prenatal diagnosis, and a positive result was found in 2 (1.3%) cases. In the IBVM group, the percentage of favorable prognosis in the mild, moderate and severe pregnancies were 94.4%, 79.2%, and 4.8%, respectively, and the termination of pregnancy (TOP) rates were 4.6%, 20.8%, and 85.7%, respectively. In both the mild and moderate NIBVM, the TOP rates progressively increased and the favorable prognosis survival rates progressively decreased relative to the soft markers, non-structural abnormalities, and structural abnormalities, respectively. Approximately 94.1% of severe NIBVM ended in termination. Conclusion Genetic disorders and fetal infection are important etiology of BVM. CMA is highly recommended for genetic disorders’ evaluation. Pregnancies with severe BVM always ended in TOP, while in mild-to-moderate NIBVM, prenatal imaging by ultrasound and/or MRI plays important roles in the pregnancy outcomes.
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Affiliation(s)
- Danhua Guo
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Deqin He
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Qingmei Shen
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Shuqiong He
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Yifang Dai
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Ying Li
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Xiaoqing Wu
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China.,Department of Laboratory Medicine, Fujian Medical University, Fuzhou, 350002, Fujian, People's Republic of China
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Mirsky DM, Stence NV, Powers AM, Dingman AL, Neuberger I. Imaging of fetal ventriculomegaly. Pediatr Radiol 2020; 50:1948-1958. [PMID: 33252761 DOI: 10.1007/s00247-020-04880-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/18/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Fetal ventriculomegaly is the most common central nervous system abnormality detected by prenatal imaging. It has a high association with other anomalies. Etiologies and prognoses for fetal ventriculomegaly range from normal outcomes to significant neurodevelopmental sequelae. In this paper, we review the development, terminology, pathogenesis, imaging and prognosis of fetal ventriculomegaly.
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Affiliation(s)
- David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA.
| | - Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Andria M Powers
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Andra L Dingman
- Division of Child Neurology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave., Box B125, Aurora, CO, 80045, USA
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Beresford C, Hall S, Smedley A, Mathad N, Waters R, Chakraborty A, Sparrow OC, Tsitouras V. Prenatal diagnosis of arachnoid cysts: a case series and systematic review. Childs Nerv Syst 2020; 36:729-741. [PMID: 31897633 DOI: 10.1007/s00381-019-04477-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/17/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Primary cysts are believed to arise from the splitting of the arachnoid membrane during prenatal development and can be diagnosed in utero. Prenatal diagnosis is uncommon; therefore, the evidence base for counselling expectant mothers is limited. The purpose of this article is to present a case series and review the current literature on prenatally diagnosed arachnoid cysts. METHOD A keyword search of hospital electronic records was performed for all patients with a prenatally diagnosed arachnoid cyst at a tertiary neurosurgical centre. Case notes were reviewed for all patients diagnosed between 2005 and 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to structure a systematic review of all English language articles published up to May 2018. RESULTS A total of eight eligible patients were identified from our own records and 123 from the literature. Sixty-eight per cent of patients had a normal outcome. Sixty-three per cent of patients underwent surgical intervention which was not associated with abnormal outcome. The diagnosis of syndromic/genetic diagnosis (p < 0.001) and the presence of other intra-cranial anatomical abnormalities (p = 0.05) were significant predictors of abnormal outcome. CONCLUSION The pathogenesis and prognosis of a prenatal arachnoid cyst diagnosis remain unclear. These results suggest favourable outcomes from simple cysts without associated abnormalities and expectant mothers should be counselled accordingly. A wider prospective review is required to better established evidence-based practice.
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Affiliation(s)
- Charles Beresford
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Samuel Hall
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Alexander Smedley
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Nijaguna Mathad
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Ryan Waters
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Aabir Chakraborty
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Owen C Sparrow
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Vassilios Tsitouras
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Pisapia JM, Akbari H, Rozycki M, Goldstein H, Bakas S, Rathore S, Moldenhauer JS, Storm PB, Zarnow DM, Anderson RCE, Heuer GG, Davatzikos C. Use of Fetal Magnetic Resonance Image Analysis and Machine Learning to Predict the Need for Postnatal Cerebrospinal Fluid Diversion in Fetal Ventriculomegaly. JAMA Pediatr 2018; 172:128-135. [PMID: 29255892 PMCID: PMC5796744 DOI: 10.1001/jamapediatrics.2017.3993] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Which children with fetal ventriculomegaly, or enlargement of the cerebral ventricles in utero, will develop hydrocephalus requiring treatment after birth is unclear. OBJECTIVE To determine whether extraction of multiple imaging features from fetal magnetic resonance imaging (MRI) and integration using machine learning techniques can predict which patients require postnatal cerebrospinal fluid (CSF) diversion after birth. DESIGN, SETTING, AND PATIENTS This retrospective case-control study used an institutional database of 253 patients with fetal ventriculomegaly from January 1, 2008, through December 31, 2014, to generate a predictive model. Data were analyzed from January 1, 2008, through December 31, 2015. All 25 patients who required postnatal CSF diversion were selected and matched by gestational age with 25 patients with fetal ventriculomegaly who did not require CSF diversion (discovery cohort). The model was applied to a sample of 24 consecutive patients with fetal ventriculomegaly who underwent evaluation at a separate institution (replication cohort) from January 1, 1998, through December 31, 2007. Data were analyzed from January 1, 1998, through December 31, 2009. EXPOSURES To generate the model, linear measurements, area, volume, and morphologic features were extracted from the fetal MRI, and a machine learning algorithm analyzed multiple features simultaneously to find the combination that was most predictive of the need for postnatal CSF diversion. MAIN OUTCOMES AND MEASURES Accuracy, sensitivity, and specificity of the model in correctly classifying patients requiring postnatal CSF diversion. RESULTS A total of 74 patients (41 girls [55%] and 33 boys [45%]; mean [SD] gestational age, 27.0 [5.6] months) were included from both cohorts. In the discovery cohort, median time to CSF diversion was 6 days (interquartile range [IQR], 2-51 days), and patients with fetal ventriculomegaly who did not develop symptoms were followed up for a median of 29 months (IQR, 9-46 months). The model correctly classified patients who required CSF diversion with 82% accuracy, 80% sensitivity, and 84% specificity. In the replication cohort, the model achieved 91% accuracy, 75% sensitivity, and 95% specificity. CONCLUSION AND RELEVANCE Image analysis and machine learning can be applied to fetal MRI findings to predict the need for postnatal CSF diversion. The model provides prognostic information that may guide clinical management and select candidates for potential fetal surgical intervention.
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Affiliation(s)
- Jared M. Pisapia
- Department of Neurosurgery, University of Pennsylvania, Philadelphia,Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Hamed Akbari
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Martin Rozycki
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Hannah Goldstein
- Department of Neurosurgery, Columbia University Medical Center, New York, New York
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Saima Rathore
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Julie S. Moldenhauer
- Center for Fetal Diagnosis and Treatment, Special Delivery Unit, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Phillip B. Storm
- Department of Neurosurgery, University of Pennsylvania, Philadelphia,Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deborah M. Zarnow
- Division of Neuroradiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Gregory G. Heuer
- Department of Neurosurgery, University of Pennsylvania, Philadelphia,Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
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Pisapia JM, Sinha S, Zarnow DM, Johnson MP, Heuer GG. Fetal ventriculomegaly: Diagnosis, treatment, and future directions. Childs Nerv Syst 2017; 33:1113-1123. [PMID: 28510072 DOI: 10.1007/s00381-017-3441-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 11/25/2022]
Abstract
Fetal ventriculomegaly (VM) refers to the enlargement of the cerebral ventricles in utero. It is associated with the postnatal diagnosis of hydrocephalus. VM is clinically diagnosed on ultrasound and is defined as an atrial diameter greater than 10 mm. Because of the anatomic detailed seen with advanced imaging, VM is often further characterized by fetal magnetic resonance imaging (MRI). Fetal VM is a heterogeneous condition with various etiologies and a wide range of neurodevelopmental outcomes. These outcomes are heavily dependent on the presence or absence of associated anomalies and the direct cause of the ventriculomegaly rather than on the absolute degree of VM. In this review article, we discuss diagnosis, work-up, counseling, and management strategies as they relate to fetal VM. We then describe imaging-based research efforts aimed at using prenatal data to predict postnatal outcome. Finally, we review the early experience with fetal therapy such as in utero shunting, as well as the advances in prenatal diagnosis and fetal surgery that may begin to address the limitations of previous therapeutic efforts.
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Affiliation(s)
- Jared M Pisapia
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA.
| | - Saurabh Sinha
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA
| | - Deborah M Zarnow
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory G Heuer
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor Silverstein Pavilion, Philadelphia, PA, 19104, USA.,The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Li H, Liu G, Lin F, Liang H. Formation of the calcarine sulcus: a potential marker to predict the progression in utero of isolated mild fetal ventriculomegaly. Medicine (Baltimore) 2017; 96:e7506. [PMID: 28700500 PMCID: PMC5515772 DOI: 10.1097/md.0000000000007506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Our previous study confirmed the negative association between the development of calcarine sulcus and the width of lateral ventricles. The purpose of current study was to evaluate the reliability of calcarine sulcus depth in the 2nd trimester to predict the prenatal enlargement of lateral ventricle in fetuses with isolated mild fetal ventriculomegaly (IMVM).This study used a retrospective cohort study design. A total of 97 pregnant women with IMVM diagnosed between 20 and 26 weeks' gestation returned for a 2nd examination at 30 to 32 weeks. Lateral ventricular size and calcarine sulcus depth were acquired from ultrasonography and magnetic resonance imaging (MRI) scans, respectively. Progression was defined as the process of developing from a lower group toward a higher (<10 mm, 10-12 mm, 13-15 mm, and ≥16 mm).Significant correlation was observed between calcarine sulcus depth and ventricular measurements at the 2nd scan (r = -0.71, P < .0001). Receiver-operating characteristic curves showed that calcarine sulcus depth (area under curve [AUC] = 0.83, 95% confidence interval [CI] = 0.74-0.92) had the best diagnostic performance in predicting the prenatal progression, as compared with lateral ventricle width (AUC = 0.69, 95%CI = 0.54-0.84) and gestational age (AUC = 0.70, 95%CI = 0.57-0.83) at the initial scan. The cutoff value for calcarine sulcus depth was 3.3 mm, with the corresponding sensitivity and specificity were 75.0% and 81.3%, respectively. Multivariate analyses showed that calcarine sulcus depth ≥3.3 mm (odds ratio = 0.09, 95%CI = 0.02-0.38, P = .001) was an independent predictor of the prenatal progression.For IMVM, calcarine sulcus depth might be a powerful marker to identify subjects at higher risk for worse prenatal progression.
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Affiliation(s)
| | - Guangjian Liu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fangqin Lin
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Gu JL, Johnson A, Kerr M, Moise KJ, Bebbington MW, Pedroza C, Sandberg DI. Correlating Prenatal Imaging Findings of Fetal Ventriculomegaly with the Need for Surgical Intervention in the First 3 Months after Birth. Pediatr Neurosurg 2017; 52:20-25. [PMID: 27676186 DOI: 10.1159/000449003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS This study evaluates the predictive value of prenatal imaging measurements regarding the need for cerebrospinal fluid (CSF) diversion for fetal hydrocephalus in the first 3 months after birth. METHODS We retrospectively reviewed a consecutive case series of patients with fetal hydrocephalus from January 2011 to December 2014 (n = 45). Prenatal measurements included head circumference (HC), biparietal diameter (BPD), and lateral ventricle (LV) width. Patients requiring CSF diversion within 12 weeks of birth were compared to those who did not require CSF diversion using the Wilcoxon rank sum test, and receiver-operating characteristic analysis was used to evaluate threshold values. RESULTS CSF diversion was required within 12 weeks of birth in 30 of 45 patients. Mean LV width (mm) during the entire pregnancy was greater for the surgery group than the nonsurgery group. Neither BPD nor HC showed differences between the groups. A mean LV size ≥15 mm predicted the need for CSF diversion with a sensitivity of 67% and specificity of 73%. CONCLUSION LV width is the prenatal imaging measurement that best predicts the need for postnatal CSF diversion.
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Affiliation(s)
- Joshua L Gu
- Departments of Pediatric Surgery and Neurosurgery, University of Texas Health Science Center at Houston - McGovern Medical School and Mischer Neuroscience Center, Houston, Tex., USA
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Melo JRT, Pacheco P, Melo END, Vasconcellos Â, Passos RK. Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:759-63. [DOI: 10.1590/0004-282x20150110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective Hydrocephalus is one of the main complications associated with myelomeningocele (MM). This study aimed to identify clinical and ultrasonographic criteria for using ventriculoperitoneal (VP) shunts in this group of patients.Method A retrospective cohort study, based on established protocol for VP shunt implant in hydrocephalic children with MM. Parameters used to guide the indication of VP shunts included measurement of head circumference (HC), evaluation of fontanels, and measurement of lateral ventricular atrium (LVA) width by transcranial ultrasonography.Results 43 children were included in the analysis, of which 74% had hydrocephalus and required a VP shunt. These children had LVA width ≥ 15 mm, showed increased HC, or had bulging fontanels.Conclusion VP shunt is required in children with increased HC (≥ 2 standard deviation regarding age group), bulging fontanels, or LVA width of ≥ 15 mm after the closure of MM.
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Senapati G, Levine D. Prenatal-postnatal correlations of brain abnormalities: how lesions and diagnoses change over time. JOURNAL OF PEDIATRIC NEURORADIOLOGY 2012; 1:171-184. [PMID: 24078783 DOI: 10.3233/pnr-2012-027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A combination of prenatal ultrasound and MRI can be used to detect and characterize many primary and secondary CNS abnormalities in the developing fetus. While this information is useful in prenatal patient counseling, it is important to understand the factors that can influence change in diagnosis and prognosis over time. The etiology of the abnormality, the conspicuity of associated findings, the change in appearance over time, and the opinion of subspecialty experts all can influence the diagnosis. Additionally, technical factors of imaging acquisition may allow the detection of an abnormality in the postnatal period and not prenatally. Having an understanding of the normal fetal central nervous system anatomy at varying gestational ages will aid in the imaging detection and interpretation of CNS pathology. Understanding how these appearances and diagnoses can change over time will aid in the discussion of prognosis with expectant parents, which is crucial in fetal CNS abnormalities.
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Affiliation(s)
- Gunjan Senapati
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215
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10
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Wang KC, Lee JY, Kim SK, Phi JH, Cho BK. Fetal ventriculomegaly: postnatal management. Childs Nerv Syst 2011; 27:1571-3. [PMID: 21928022 DOI: 10.1007/s00381-011-1556-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION It is the current status of fetal ventriculomegaly that although the technology for diagnosis is advanced, it does not have significant impact on the management outcome. Fetal ventriculomegaly is mainly treated after birth. METHODS We reviewed the literature and suggested policies of postnatal evaluation and surgical management of fetal hydrocephalus. Our experience of 44 cases of fetal ventriculomegaly diagnosed by fetal ultrasonography, in which major poor prognostic factors were absent and for which prenatal pediatric neurosurgical consultation was sought, was also presented. RESULTS Our experience showed etiologic heterogeneity of fetal ventriculomegaly although our cases seemed to be surgical candidates more likely than whole group of fetal ventriculomegaly. There were limitations in prenatal evaluation of fetal hydrocephalus. The first step for postnatal management is etiologic classification. It should be clarified after birth whether there is remarkable disturbance of cerebrospinal fluid dynamics or not. The rate of postnatal progression of ventricular dilatation is also important for the decision of treatment plan. For surgical treatment in very young children, special considerations should be paid on technical feasibility, rate of postoperative infection or malfunction, prevention of rapidly developing nervous system from the possible damage, and great plasticity of young brain. CONCLUSION Indication, methods, and timing of surgical treatment must be individually tailored according to the etiology, degree and rate of progression of ventriculomegaly, and patient's age when surgical treatment is considered.
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Affiliation(s)
- Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-769, South Korea.
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Hankinson TC, Vanaman M, Kan P, Laifer-Narin S, Delapaz R, Feldstein N, Anderson RCE. Correlation between ventriculomegaly on prenatal magnetic resonance imaging and the need for postnatal ventricular shunt placement. J Neurosurg Pediatr 2009; 3:365-70. [PMID: 19409014 DOI: 10.3171/2009.1.peds08328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT Pediatric neurosurgeons are increasingly called on to provide prognostic data regarding the antenatal diagnosis of ventriculomegaly. This study was designed to determine if there is a correlation between prenatal MR imaging results and the need for ventricular shunt placement during the neonatal period. METHODS The authors retrospectively reviewed the prenatal MR imaging data of 38 consecutive patients who had been referred for neurosurgical consultation following the diagnosis of ventriculomegaly. The outcome measure was placement of a ventricular shunt. Assessed parameters included prenatal atrial diameter (AD), gestational age at MR imaging, time between imaging studies, presence of concomitant CNS anomalies, laterality of ventriculomegaly, fetal sex, and temporal evolution of ventriculomegaly. Logistic regression analysis was completed with the calculation of appropriate ORs and 95% CIs. RESULTS Six patients (16%) required shunt placement, all with an AD > or = 20 mm (mean 23.8 mm) at the time of imaging. Eight patients had presented with an AD > or = 20 mm. Atrial diameter was the only presenting feature that correlated with shunt placement (OR 1.58, 95% CI 1.10-2.25, p = 0.01). Logistic regression analysis revealed no statistical correlation between the need for ventricular shunting and gestational age at MR imaging, time between imaging studies, fetal sex, presence of additional CNS anomalies, and laterality of the ventriculomegaly. CONCLUSIONS When assessed using MR imaging, an AD > or = 20 mm at any gestational age is highly associated with the need for postnatal shunting. Patients with concomitant CNS anomalies did not require shunts at a greater rate than those with isolated ventriculomegaly. Further studies are required to assess the long-term outcome of this patient population.
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Affiliation(s)
- Todd C Hankinson
- Department of Neurosurgery, Columbia University, New York, New York 10032, USA.
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