Etiology, Prenatal Diagnostics and Outcome of Ventriculomegaly in 230 Cases

Abstract

Objective: The aim of this study was to review and summarize the information regarding the etiology, diagnostics and outcome of ventriculomegaly. Methods: The study included 230 cases of ventriculomegaly examined between 1979 and 2000. The main diagnostic criterion for ventriculomegaly was the transverse diameter of the ventricular atrium at the level of the glomus of the chorioid plexus measuring >10 mm, irrespective of gestational age. Results: Gender distribution (male:female ratio: 0.98) coincided with that of the general population. In 32% of the cases (72/230), the history was positive; 6% (12/230) had a positive genetic history, while 26% (60/230) were associated with pathological obstetric events. The incidence rate of ventriculomegaly in the patients’ history was found to be 2.61% (6/230). In nearly 60% of the cases included in this study, ventriculomegaly was diagnosed before the 24th week of pregnancy. Fresh fetal infection confirmed by Toxoplasma PCR real-time examination was diagnosed only in cases of severe ventriculomegaly. Based on the measurement of the diameter of the atrium of the lateral ventricle, severe and mild ventriculomegaly was diagnosed in 142/230 (61.7%) and 88/230 cases (38.3%), respectively. Termination of pregnancy was significantly more frequent in cases of severe than of mild ventriculomegaly (92 vs. 66%). Conclusions: The importance of positive obstetric and/or genetic history should be emphasized as it is in direct relationship with the increased incidence of this malformation. Regarding the practice of ultrasonography, mild ventriculomegaly (transverse diameter of the lateral ventricle <15 mm) has a much better prognosis than the severe form (transverse diameter of the lateral ventricle >15 mm) of the malformation. Based on the ultrasonographic diagnosis of ventriculomegaly, TORCH serological examination is also recommended since treating toxoplasmosis by medication may have a promising prognosis for the pregnancy. In cases of isolated ventriculomegaly alone, intrauterine karyotyping is not necessarily indicated, but in cases where ventriculomegaly is associated with other genetic disorders karyotyping should definitely be performed. Since ventriculomegaly is not incompatible with postnatal life by itself, the decision about the fate of the pregnancy is largely dependent on the presence of other organic disorders.

Clinical Characteristics and Perinatal Outcome of Fetuses with Ventriculomegaly

“…In our series, 53% of the fetal VM cases were diagnosed ≤ 24 weeks' and 7.4% after 32 weeks' gestation. Joo´ et al reported that 60% of the prenatal diagnosis in their series was made before the 24th gestational weeks' [14]. Incidences of mild, moderate and severe VM cases in our study group are also in accordance with other studies [5,15].…”

“…The mean maternal age and the average gestational age at the rst diagnoses of fetal VM cases in our study population are similar to those reported in the literature [5,8,14]. In our series, 53% of the fetal VM cases were diagnosed ≤ 24 weeks' and 7.4% after 32 weeks' gestation.…”

“…In clinical practice, fetal MRI is commonly used as an adjunct to improve diagnostic accuracy for brain abnormalities and can be used to identify subtle CNS anomalies overlooked at the ultrasound [5,6,7,14]. Fetal brain MRI has been accepted as a complementary method, however the indications and further value of this method, have not been fully established [17].…”

Surgical Outcomes of Third Ventriculostomy in Patients of Obstructive Hydrocephalus

“…Treatment strategies for obstructive hydrocephalus have been thoroughly explored, and numerous studies have investigated exclusive treatment strategies and their effectiveness. ETV is a preferred technique for obstructive hydrocephalus rather than traditional shunting procedures in selected patients at neurosurgical centers in developing countries with neuroendoscopy facility and expertise 17 . This growing popularity is because of the fact that ETV affords the patient with shunt-free functionality and is successful remedy for hydrocephalus no matter etiology, patient age, and other elements 18 .…”