Prenatal Ventriculomegaly – Diagnosis, Prognostication and Management

Abstract

Fetal ventriculomegaly (VM) refers to the abnormal enlargement of one or more ventricles of the brain in-utero. The enlargement may or may not be related to ventricular obstruction and increased intracranial pressure; therefore, the term “hydrocephalus” is not used. VM is diagnosed usually in the mid-trimester when the atrial diameter (AD) of the lateral ventricle is more than 10 mm on one or both sides. A thorough workup is then required to identify the cause as the etiology is diverse. Fetal magnetic resonance imaging (MRI) may yield additional information. Serial ultrasound follow-up would be required to assess its progression with advancing gestation. The prognosis and long-term outcomes greatly depend upon the etiology, the severity at diagnosis, progression, and associations. This article reviews the definitions, diagnosis, and workup of fetal VM, discusses follow-up protocols and prognosis, and examines the role of fetal therapy, including fetoscopic surgery in its prenatal management.

Normal values of the fronto‐occipital relationship in fetuses between 18 and 40 weeks at two maternal fetal medicine units: Bogotá, Colombia

“…The average maternal age was 28.1 ± 6.4 (12–48) years. The average number of performed prenatal evaluations was 4.4 ± 2 1–11 . The 62.4% ( n = 610) of the patients had at least one previous pregnancy.…”

“…The biometry of the ventricular system is performed by measuring the ventricular atrium, 6 angle of the choroid plexus, 7 relationship of the choroid plexus with the walls of the lateral ventricle, 8 and thalamus-occipital distance. 9 Of these, the universally recommended ultrasound parameter is the measurement of the lateral ventricle, which at present cannot be extrapolated to neonatal measurements. 1,3,6,10,11 Although these measurements have classically been established by obstetric ultrasound, 10 the MRI of the fetal brain has gained prominence allowing measurements being comparable to those performed in pediatric populations.…”

“…Currently, in the prenatal phase of life, the brain structures have parameters verified by ultrasound. The biometry of the ventricular system is performed by measuring the ventricular atrium, 6 angle of the choroid plexus, 7 relationship of the choroid plexus with the walls of the lateral ventricle, 8 and thalamus‐occipital distance 9 . Of these, the universally recommended ultrasound parameter is the measurement of the lateral ventricle, which at present cannot be extrapolated to neonatal measurements 1,3,6,10,11 .…”

“…G R A P H 1 Distribution of patients by gestational age.T A B L E 2Prenatal controls mean (SD) (min-max) 4,4 ± 2(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) …”