Ventriculomegalia leve fetal aislada. Comunicación de un caso

La ventriculomegalia es un marcador del desarrollo cerebral anormal por lo cual es causa de preocupación cuando está presente. Tiene una prevalencia de 0,3 a 1/1000 nacidos vivos y es más frecuente en fetos varones. La ventriculomegalia es definida como el diámetro atrioventricular de los ventrículos laterales mayor o igual a 10 mm. La medida de 10-15 mm constituye la ventriculomegalia leve mientras valores > 15 mm constituye la ventriculomegalia severa. La ventriculomegalia puede ser aislada o estar asociada con otras anomalías incluyendo hallazgos estructurales anormales, anomalías cromosómicas o infecciones prenatales en cerca del 50-84% de los casos. Si la ventriculomegalia es leve y aislada, el resultado más frecuente es la normalidad. La sobrevida de los recién nacidos con ventriculomegalia leve aislada es alta, con reportes del 93-98%. La probabilidad de un neurodesarrollo normal es mayor al 90% y no será diferente al de la población general, por lo cual, ante una ventriculomegalia leve aislada, después de una completa evaluación, la gestante debe ser informada que el pronóstico es favorable y que probablemente el niño será considerado normal. Presentamos un caso de ventriculomegalia leve fetal izquierda aislada detectada en la ecografía prenatal de las 20 semanas, a quien se le realizó controles neurosonográficos seriados, amniocentesis genética y estudio de infecciones prenatales, siendo estos dos últimos normales y evidenciándose resolución de la ventriculomegalia, así como control posparto dentro de los límites de la normalidad.

Ventriculomegaly is a marker of abnormal brain development and is a cause for concern when present. It has a prevalence of 0.3-1/1000 live births and is more frequent in male fetuses. Ventriculomegaly is defined as the atrioventricular diameter of the lateral ventricles greater than or equal to 10 mm. A measurement of 10-15 mm constitutes mild ventriculomegaly while values >15 mm constitute severe ventriculomegaly. Ventriculomegaly may be isolated or associated with other anomalies including abnormal structural findings, chromosomal abnormalities or prenatal infections in about 50-84% of cases. If ventriculomegaly is mild and isolated, the most frequent outcome is normal. Survival of newborns with isolated mild ventriculomegaly is high, with reports of 93-98%. The probability of normal neurodevelopment is greater than 90% and will not be different from that of the general population. Therefore, in the presence of isolated mild ventriculomegaly, after a complete evaluation, the pregnant woman should be informed that the prognosis is favorable, and that the child will probably be considered normal. We present a case of isolated mild left ventriculomegaly detected in the prenatal ultrasound at 20 weeks, who underwent serial neurosonographic controls, genetic amniocentesis and study of prenatal infections, the latter two being normal and showing resolution of ventriculomegaly, as well as postpartum control within the limits of normality.

CONGENITAL CYTOMEGALOVIRUS INFECTION AND ITS EFFECTS ON FETUS A CASE REPORT

Cytomegalovirus infection during pregnancy is very common. Vertical transmission is possible in all three trimester of pregnancy. 1 in 150 children are born with congenital Cytomegalovirus infection. It is the most common infective cause of mental handicap in newborn, Congenital Cytomegalovirus infection can cause sensorineural deafness, developmental delay and even fetal death. We present a case of Isolated bilateral ventriculomegaly at 33 weeks 4 days diagnosed as congenital Cytomegalovirus infection. Careful maternal and fetal monitoring and timely intervention leads to good fetal outcome.

AVID triad: a case report

Asymmetric ventriculomegaly, interhemispheric cyst and dysgenesis of the corpus callosum (AVID) constitutes a rare imaging triad. Additional findings include subcortical and subependymal heterotopia, polymicrogyria, fused thalami, deficient falx, and hydrocephalus. The knowledge of this triad helps us to diagnose prenatally by sonography and fetal MRI. In this case report authors present MRI Imaging findings in a case of AVID syndrome in a 6year old male child presenting with history of seizures and delayed milestones.

Evaluation of the incidence, risk factors, severity, and outcome of hydrocephalic fetuses in a tertiary healthcare center located in Northern India: a prospective observational study

Background: Hydrocephalus is a heterogeneous disease marked by abnormal dilatation of the cerebral ventricles secondary to varying etiologies. This study was aimed to determine the incidence, risk factors, severity, and outcome of hydrocephalic fetuses presenting to a tertiary healthcare hospital located in northern India.Methods: In this prospective observational study, pregnant women visiting the obstetrics outpatient department of our hospital from 01 July 2017 to 31 June 2018 were screened for hydrocephalic fetuses via ultrasonography along with a detailed history, and a comprehensive battery of diagnostic investigations. They were followed up for a minimum period of two months after delivery/termination of pregnancy.Results: A total of 3627 pregnant women were screened, of which 10 had hydrocephalic fetuses in the observed time period. The incidence of hydrocephalus was determined to be 2.75 per 1000 live births. Low socio-economic status was identified as a major risk factor. 50% of the hydrocephalic fetuses were severely afflicted and were discontinued. The remaining 50% were successfully delivered and were managed via a ventriculo-peritoneal shunt or are under close observation in the postnatal period without any adverse outcome.Conclusions: The burden of hydrocephalus is considerably high in India, as compared to western countries. In rural settings, low socioeconomic status and lack of folic acid supplementation have a major influence in the etiopathogenesis of hydrocephalus. Management of hydrocephalus requires a multidisciplinary approach and is tailored according to the severity of the presentation. Severe cases of hydrocephalus and cases with associated anomalies have a poor prognosis.

Diagnóstico prenatal de ventriculomegalia e hidrocefalia fetal / Prenatal diagnosis of ventriculomegalia and fetal hydrocephalia

La Ventriculomegalia y la hidrocefalia fetal son enfermedades complejas y multifactoriales. El tamaño del sistema ventricular cambia durante el embarazo excepto el atrio que se mantiene estable entre 6 a 8 mm, desde la 15 a las 40 semanas gestacionales. Cuya incidencia es de hasta 2 por 1000 nacimientos. Puede asociarse con hidrocefalia, pero también puede estar relacionado con disminución del tejido cerebral normal. El desarrollo neurológico puede correlacionarse con la gravedad de la ampliación ventricular, la cual varía según a causa y la presencia de otras malformaciones asociadas. Las causas de ventriculomegalia, son casi las misma de la hidrocefalia, ya que en ambos existe un aumento del perímetro cefálico, pero existe también casos de ventriculomegalia, sin problemas con la cantidad de líquido cefalorraquídeo, como en la atrofia cerebral por infección intracraneana, daño de sustancia blanca y hemorragia focal. Dentro de los criterios prenatales debe destacarse, antecedentes de madre con polihidramnios, hallazgos ultrasonográficos fetales de ventriculomegalia, niveles altos de alfa feto proteína sérica materna o del líquido amniótico. El diagnóstico prenatal se realiza gracias al advenimiento de la ecografía prenatal de alta resolución, logrando observarse la dilatación ventricular de rutina dentro del útero. Ayudado por la resonancia magnética y es confirmado al nacimiento.

Ventriculomegalyand fetal hydrocephalus are complex and multifactorial diseases. The size of the ventricular system changes during pregnancy and the atrium remains between 6 to 8 mm, from 15 to 40 gestational weeks. Whose incidence is up to 2 per 1000 births. It may be associated with hydrocephalus, but it may also be related to the injury of normal brain tissue. Neurological development can be correlated with the severity of ventricular enlargement, which varies according to the cause and the presence of other associatedmalformations. The causes of ventriculomegaly are almost the same as hydrocephalus, and in both cases there is an increase in the cephalic perimeter, but there are also cases of ventriculomegaly, without problems with the amount of cerebrospinal fluid, asin the cerebral atrium due to intracranial infection, damage of white matter and focal hemorrhage. Within the prenatal criteria should be noted, mother's history with polyhydramnios, fetal ultrasound findings of ventriculomegaly, high levels of alpha fetus, maternal serum protein or amniotic fluid. The prenatal diagnosis is made thanks to the advent of high resolution prenatal ultrasound, making it possible to observe routine ventricular dilatation within the uterus. Helped by magnetic resonance and is confirmed at birth.

The types of abnormalities and clinical significance in fetus with non-isolated cerebral ventriculomegaly / 实用医学杂志

Objective To analysis the common abnormalities in fetus with ventriculomegaly and clinical significance. Methods Collected from March 2010 to December 2016,298 cases of pregnant women whose fetus with ventriculomegaly and accepted the prenatal diagnosis of pregnancy,including 109 cases of isolated cerebral ventriculomegaly(IVM),and 189 cases of non-isolated cerebral ventriculomegaly(NIVM).They were divided into mild groups(10.0-11.9 mm),moderate group(12.0-14.9 mm)and severe group(≥15.0 mm)according to the width of the lateral ventricle. Results(1)The most common abnormality of the NIVM were neurodevelopmental system(37.30%,94/252);The second was ultrasonic soft index(27.78%,70/252).(2)The most frequent combi-nation in mild group was ultrasonographic soft mark anomalies(44.76%,47/105),followed by other ultrasonic indi-cators(18.10%,19/105).The abnormal incidence of central nervous system was higher in middle group(45.16%, 42/93),followed by ultrasonic soft index abnormality(21.51%,20/93).The abnormality of the central nervous sys-tem was 62.96%(34/54)in severe group,followed by an abnormal(14.81%,8/54).(3)There was a difference in the nervous system and the ultrasonic-soft indicator between the non-isolated lateral ventricle dilation with different lateral ventricle widths(P<0.001).There was no difference in cardiovascular abnormalities. Conclusion Prena-tal ultrasound revealed that fetus with cerebral ventriculomegaly should carefully examine whether other abnormali-ties existed to determine the prognosis of the fetus and whether intervention should be taken.There was a difference between the different types of lateral ventricle and the prognosis.

Pregnancy outcomes and neurodevelopment in 173 cases of mild or moderate fetal ventriculomegaly / 中华围产医学杂志

Objective To investigate pregnancy outcomes and neurodevelopment in fetuses with ventriculomegaly. Methods This was a cohort study of 173 gravidas with singleton pregnancy who were diagnosed with fetal ventriculomegaly by ultrasound in Prenatal Diagnostic Center of Nanfang Hospital Affiliated to Southern Medical University from March 2010 to July 2016. Thirty normal gravidas who received antenatal care in the same hospital and at the same period were selected as control. Clinical data were collected. Gravidas who had chosen to continue their pregnancy were followed up to monitor the variations of fetal ventricular. Fetal mild and moderate ventriculomegaly were respectively defined as a ventricular atrial width of 10-12 mm and >12 mm but <15 mm. Isolated ventriculomegaly (IVM) indicated those without any other ultrasound abnormalities, otherwise the case would be defined as non-isolated ventriculomegaly (NIVM). Among the 173 gravidas, 54 cases were mild IVM, 53 mild NIVM, 26 moderate IVM and 40 moderate NIVM. Fetuses with chromosome abnormalities were excluded from the study. Neonatal behavioral neurological assessment (NBNA) was used to analyze the neonatal neurodevelopment at the age of 7 days, and Bayley scales of infant development was used to evaluate the development of nervous system at the age of 6 months through analyzing their mental development index (MDI) and psychomotor development index (PDI). Statistical methods included t test, χ2 test (or Fisher's exact test), nonparametric test, Mann-Whitney test and multiple Kruskal-Wallis H test. Results (1) Among the 107 fetuses with mild ventriculomegaly, 72.9％ (78), 23.4％ (25) and 3.7％ (4) of them regressed, stabilized and progressed,respectively; however, among the 66 moderate cases, the figures were 45.4％ (30), 37.9％ (25) and 16.7％ (11) respectively (χ2=15.769, P<0.001). For those in the IVM and NIVM subgroups within the moderate ventriculomegaly group, significant difference was shown [17(65.4％), 8(30.8％) and 1(3.8％) vs 13(32.5％), 17(42.5％) and 10(25.0％), χ2=8.552, P=0.014], but not within the mild groups (χ2=2.412, P=0.299). (2) There were 164 gravidas who continued their pregnancy and delivered. Significant differences in NBNA score were observed between the ventriculomegaly group and the control (37.70±1.80 vs 38.53±1.38, t= - 2.424, P<0.05). Numbers of neonates with NBNA score < 36 and ≥ 36 points were 5(4.7％) and 101(95.3％) in the mild group, and 8(13.8％) and 50(86.2％) in the moderate group (χ2=4.231, P=0.004). There was significant difference in NBNA score between the IVM and NIVM subgroup within neither mild nor moderate group (χ2 were 0.210 and 0.201, P were 1.000 and 0.720). (3) Totally, 137 cases completed the assessment of nervous system development at the age of 6 months. There was significant difference in PDI score between the ventriculomegaly group and the control (90.50±10.85 vs 95.80±9.65, t= - 2.471, P=0.014), but not in MDI score (95.42+11.20 vs 99.50+12.00, t= - 1.786, P=0.076). (4) The comparison of the proportion of excellent, average and poor PDI scores: Significant differences were found between the IVM and NIVM subgroup within the moderate ventriculamegaly group and in the different intrauterine outcome groups [IVM vs NIVM groups: 3(15.0％), 16(80.0％) and 1(5.0％) vs 1(3.1％), 24(75.0％) and 7(21.9％),Z= - 2.097, P=0.036;intrauterine regression, stable and progress group: 9(10.6％), 75(88.2％) and 1(1.2％);3(6.5％), 37(80.4％) and 6(13.1％) vs 0, 2(2/6) and 4(4/6), χ2=19.808, P<0.001], but not between the mild and moderate vetriculamegaly group, or between the subgroups within the mild ones (Z were - 1.869 and - 1.946, P were 0.062 and 0.052). (5) The comparison of the proportion of excellent, average and poor scores of MDI: Significant difference was only found among the different intrauterine outcome groups[13(15.3％), 71(83.5％), 1(1.2％); 2(4.4％), 41(89.1％), 3(6.5％) vs 0, 5(5/6), 1(1/6); χ2=7.980, P=0.018], but not in any other comparisons (all P>0.05). Conclusions Prognosis of fetal ventriculomegaly is affected by co-existed abnormalities and intrauterine progression. Fetus with mild ventriculomegaly can also have risk of abnormal neural development, suggesting that we should pay much attention to such cases and a regular follow-up is required.

Defecto amplio del tubo neural: A propósito de un caso / Open neural tube defect: A case report

Los defectos del tubo neural representan la segunda causa de malformación congénita más frecuentes del desarrollo prenatal y constituyen el 10% de las mismas. Su origen suele ser multifactorial, dando lugar a un cierre incompleto o defectuoso del neuroporo anterior y/o posterior, y ocasionando diferentes niveles de defectos en el sistema nervioso central. A pesar de toda la investigación realizada, nuestros conocimientos sobre la etiología genética de esta malformación son todavía muy limitados. Se desconoce cuántos genes pueden conferir riesgo de anomalía en el desarrollo del tubo neural. El diagnóstico se basa principalmente en el estudio ecográfico del sistema nervioso central en el segundo trimestre de la gestación, aunque su valoración en el primer trimestre nos permite una aproximación diagnóstica bastante confiable por la presencia de marcadores ecográficos descritos hace pocos años. Una vez confirmado el diagnóstico el manejo depende (en países como España en donde se permite el aborto) de la voluntad de los padres de continuar o no con la gestación; y en caso de continuar, existen opciones de tratamiento quirúrgico intrauterino o posterior al nacimiento. El pronóstico de esta malformación suele ser variable y depende de localización, tamaño y su asociación o no con hidrocefalia.

Neural tube defects are the second most frequent cause of congenital malformation during prenatal development. They constitute 10% of them. The origin is usually multifactorial, and it results in an incomplete or defective closure of the anterior or posterior neuropore, causing different levels of defects in the central nervous system. Despite all the research done, our knowledge of genetics in this topic is very limited so we don't know how many genes can confer risk of anomaly in the development of the neural tube. Diagnosis is mainly based on the ultrasound study of the central nervous system generally during the second trimester. Nevertheless, assessment in the first trimester allows us a fairly reliable diagnostic approach by means of the echographic markers described a few years ago. Once the diagnosis is confirmed, and if abortion is allowed in the country, the management depends on the parents' willingness to continue or not with the gestation. In case of continuing with it, there are options for intrauterine or post-natal surgical treatment. The prognosis of this malformation is usually variable and depends on location, size and its association or not with hydrocephalus.

Application value of chromosomal microarray analysis in prenatal diagnosis of lateral ventriculomegaly fetuses / 解放军医学杂志

Objective To analyze the genetic etiology of lateral ventriculomegaly fetal on the genome-wide level with chromosomal microarray analysis (CMA),and investigate the relationship between copy number variations (CNVs) and lateral ventriculomegaly and the application value of CMA in prenatal diagnosis of fetuses with lateral ventriculomegaly.Methods Seventy fetuses with lateral ventriculomegaly but normal or uncertain karyotype were selected and invasive prenatal diagnosis was performed in Xi Jing Hospital of the Fourth Military Medical University from Jan.2015 to Nov.2016.Microarray testing was performed using Affymetrix CytoScanTM 750k arrays and the results were analyzed according to biological information science database.The fetal development was regularly inspected,and follow up was conducted to find out the pregnancy outcome and fetal postnatal conditions.Results In 70 cases of lateral ventriculomegaly fetuses,there were 9 fetuses with pathogenic copy number variations (CNVs),3 fetuses with likely pathogenic CNVs and 1 fetus with likely pathogenic 1 oss of heterozygosity (LOH).During the 70 fetuses with lateral ventriculomegaly,2 pathogenic CNVs were detected in 6 fetuses with severe and non isolated lateral ventriculomegaly (33.3％).Pathogenic CNVs was not detected but 1 likely pathogenic CNV was detected in 3 fetuses with severe and isolated lateral ventriculomegaly (33.3％).Six pathogenic CNVs were detected in 31 mild and non isolated lateral ventriculomegaly (19.4％),and 2 likely pathogenic CNVs were also detected in these group (6.5％).One pathogenic CNV and 1 likely pathogenic CNV were detected in 30 fetuses with mild and isolated fetal lateral ventriculomegaly.Conclusions CMA can identify chromosome abnormality microdeletion/microduplication which was unrecognizable by conventional karyotyping analysis.The application of CMA may increase the detection rate of pathogenic CNVs in fetuses with lateral ventriculomegaly,and benefit evaluation of fetal prognosis in prenatal genetic counselling.

Diffusion weighted imaging research in fetus with mild ventriculomegaly / 中国医学影像技术

Objective To explore the diagnostic value of ADC values in fetus with mild ventriculomegaly.Methods Fifteen fetuses with mild ventriculomegaly (mild ventriculomegaly group) and fifteen healthy controls (control group) were scanned with DWI.The ADC values in bilateral frontal lobes,parietal lobes,temporal lobes,occipital lobes,basal ganglia,thalamus and cerebella were measured.The ADC values of mild ventriculomegaly group were compared with those of control group.And the ADC values in left regions were compared with those in right regions of fetuses with mild ventriculomegaly.The correlation between ADC values of all fetuses and gestational age,as well as the correlation between the diameters of ventriculomegaly in feutes with mild ventriculomegaly and gestational age were analyzed.Results Compared with control group,ADC values were lower in bilateral frontal lobes and parictal lobes in mild ventriculomegaly group (all P＜ 0.05).There were no significant differences of ADC values between left regions and right regions (all P＞0.05).Correlation analysis showed that ADC values of all fetuses in bilateral occipital lobes,basal ganglia,thalamus,cerebella and left temporal lobe were negatively correlated with gestational age.The diameters of ventriculomegaly were positively correlated with gestational age (r=0.635,P=0.011).Conclusion The ADC values decrease in frontal lobes and parietal lobes in fetuses with mild ventriculomegaly.The ADC value may be more sensitive for detecting potential damage of brain,which is helpful for the diagnosis of fetus ventriculomegaly.

Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly / Resultado neurológico em fetos com ventriculomegalia leve e moderada

Abstract Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10- 15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Resumo Introdução Ventriculomegalia (VM) é uma das anomalias mais frequente no ultrassom pre-natal. Ressonâncias magnéticas (RM) melhoram a precisão do diagnóstico e previsão do desenvolvimento em recém-nascidos. Objetivo A proposta deste estudo foi avaliar a correlação entre ultrassom e RM em fetos com leve e moderada VM isolada. O objetivo secundário foi reportar o resultado neurológico na idade de 4 anos. Métodos Fetos com diagnóstico pré-natal pelo ultrassom de VM foram identificados na idade de 4 anos. Ventriculomegalia foi definida como medida do átrio do ventrículo lateral entre 10-15 mm, a qual foi subdividida em leve (10,1-12,0 mm) e moderada (12,1-15,0 mm). Fetos com VM foram seguidos nos períodos pré-natal e pós-natal por ultrassom e RM. O resultado neurológico foi realizado usando a escala de desenvolvimento mental de Griffiths, quando indicada, até a idade de 4 anos. Resultados Sessenta e dois fetos foram identificados. Ventriculomegalia bilateral ocorreu sem 58% dos casos. Uma dilatação estável foi observada em 45%, progressiva em 13% e regressiva em 4,5% dos casos, respectivamente. Ressonância magnética fetal foi realizada em 54 fetos, e foi concordante com os achados do ultrassom em 85% dos casos. Desenvolvimento neurológico anormal foi observado em 9,6% dos casos. Conclusão Fetos nos quais ocorreu progressão da VM são de alto risco para desenvolvimento neurológico anormal. Apesar do ultrassom e da RM mostrarem substancial concordância na definição do grau de dilatação ventricular, uma baixa correlação foi vista na avaliação da VM associada ou não com anomalias do sistema nervoso central.

Reference Ranges of Fetal Cerebral Lateral Ventricle Parameters by Ultrasonography / Intervalos de referência para parâmetros do ventrículo lateral de cérebros fetais por ultrassonografia

Abstract Objectives This study was done to evaluate the normal fetal cerebral lateral ventricle dimensions with transabdominal ultrasonography. The atrial width (AW), ventricle-tochoroid measurement (V-C), ventricle-to-hemisphere ratio (VHR), and combined anterior horn measurement (CAHM) were taken. Methods This was a cross-sectional study involving 400 normal singleton pregnant subjects whose gestational ages were between 14 and 40 weeks. Transabdominal sonography was performed to obtain the values of the fetal cerebral lateral ventricle (FCLV) parameters. Data were reported as mean standard deviation (SD) for continuous variables. The degrees of correlation between FCLV parameters and the estimated gestational age (EGA) were obtained using Pearson's correlation. Regression equations were used to generate the reference limits for the FCLV measurements. Results The values of AW, V-C measurements and CAHM increased with advancing gestation. The mean values of the AW, V-C and CAHM from 14 to 40 weeks increased from 6.60 0.94 mm to 9.75 0.07 mm (R2 = 0.114), 0.80 0.00 mm to 1.90 0.14 mm (R2= 0.266), and 6.95 0.06 mm to 23.07 4.02 mm (R2= 0.692) respectively, while the mean VHR decreased from 61.20 1.60% to 42.84 2.91% (R2 = 0.706) over the same period. Conclusion The AW, V-C, and CAHM increase, while VHR decreases with advancing gestation.

Resumo Objetivos O presente estudo objetiva avaliar as dimensões do ventrículo lateral de cérebros fetais por meio de ultrassonografia transabdominal. Foram medidos a largura do átrio (LA), a medida do ventrículo ao coroide (V-C), a razão ventrículo/ hemisfério (RVH), e a medida dos cornos anteriores combinados ( CAC ). Métodos Estudo transversal com 400 grávidas de único feto com idades gestacionais entre 14 e 40 semanas. Sonografias transabdominais foram realizadas para obter os valores dos parâmetros do ventrículo lateral de cérebros fetais (VLCF). Dados foram apresentados em média desvio padrão para variáveis contínuas. Os graus de correlação entre parâmetros de VLCF e idade gestacional estimada foram obtidos usando a correlação de Pearson. Equações de regressão foram usadas para gerar as referências-limite para medidas de VLCF. Resultados Os valores de LA, medida do V-C e CAC aumentaram com o avanço da gestação. Os valores médios de LA, V-C e CAC de 14 a 40 semanas aumentaram de 6,60 0,94 mm a 9,75 0,07 mm (R2 = 0,114), de 0,80 0,00 mm a 1,90 0,14 mm (R2 = 0,266), e de 6,95 0,06 mm a 23,07 4,02 mm (R2 = 0,692), respectivamente, enquanto a RVH média diminuiu de 61,20 1,60% para 42,84 2,91% (R2 = 0,706) no mesmo período. Conclusão A LA, V-C, e CAC aumentaram, enquanto a RVH diminuiu com o avanço da gestação.

Enfoque perinatal de la ventriculomegalia / Perinatal approach of ventriculomegaly

La Ventriculomegalia Fetal es relevante dado que tiene una alta prevalencia e importante asociación con otras anomalías en el Sistema Nervioso Central. El enfoque perinatal está íntimamente ligado al desarrollo de la Medicina Materno Fetal e implica una evaluación precoz de la anatomía del SNC fetal, utilizando como herramienta de apoyo la ultrasonografía, se debe tener un claro conocimiento de la anatomía cerebral fetal, de los criterios diagnósticos y protocolos estandarizados de manejo clínico actual. Considerar el uso de Resonancia Nuclear Magnética Fetal como técnica complementaria, y proporcionar Consejo Médico a los padres apoyado en Equipos Multidisciplinarios. La presente Revisión tiene el propósito de ser una puesta al día, que sea útil para los profesionales clínicos.

The Fetal ventriculomegaly is relevant since it has a high prevalence and association with other anomalies in the Central Nervous System. The perinatal approach is closely linked to the development of Maternal-Fetal Medicine and involves an early assessment of the anatomy of fetal CNS, using as a support tool ultrasonography, one must have a clear understanding of the fetal brain anatomy, diagnostic criteria and standardized protocols current clinical management. Consider using Nuclear Magnetic Resonance Fetal as a complementary technique, and provide parents Medical Council supported by multidisciplinary teams. This review is an update that is useful for clinicians.

Clinical evaluation and ultrasonic diagnosis of mild ventriculomegaly in fetuses / 局解手术学杂志

Objective To evaluate the importance of the prenatal diagnosis to fetus with mild ventriculomegaly ( MVM) in pregnancy outcome and prognosis. Methods The ultrosonographic results of 51 pregnant women who were admitted to our hospital were collected in this study. In each case,a thorough evaluation of fetal anatomy was performed,karyotyping or MRI was done if needed,and follow-up was done un-til afterbirth. Results In 51 cases of lateral ventriculomegaly fetal:ultrasonography indicated there were 26 fetuses with mild ventriculomega-ly. The incidence of MVM complicated with other abnormities was 46. 0%,and that complicated with chromosome disorder was 11. 5%. Con-clusion Ultrasonography plays an important role in the detection of MVM. Chromosome analysis should be carried out for elder pregnant women when their fetuses are diagnosed as MVM and other complicating abnormities.

Ultrasound Reference Range for Diameters of Posterior Atrium of Lateral Ventricles for Normal Nigerian Foetuses, at the University College Hospital (UCH) Ibadan, Nigeria: A Cross – Sectional Study.

Aims: The diameter of the posterior atrium of the lateral cerebral ventricles (PALV) does not vary substantially in size during foetal development and has thus become a stable marker for the identification of foetal ventriculomegaly in developed countries. Currently, the accepted upper limit of PADLV is 10 mm. Ventricular atrial diameters greater than 10mm require more radiological evaluation to rule out ventriculomegaly. The aim of this study was to establish the normal range of values for the posterior atrium [PA] of foetal lateral ventricles in our environment and to determine a cut-off value for prenatal diagnosis of ventriculomegaly. Methods: The mean of two measurements was obtained from the transverse diameter of the atrium of the lateral ventricles of foetuses that met the inclusion criteria, as part of the routine obstetric ultrasound scan at the antenatal clinic or ultrasound suite of radiology department of the University College Hospital (UCH), Ibadan. The SPSS version 15 was used to analyse the data obtained. Results: The mean posterior atrial diameter [PAD] of the lateral ventricl was 6.5mm with standard deviation (SD) 1.3mm and mean ±2SD 3.9–9.1mm. Male foetuses had larger atrial diameters than female. Student’s t-test and Pearson’s correlation coefficient were used to explore association. Conclusion: With the existing resources in our environment, prenatal screening for ventriculomegaly during routine obstetric scan is achievable. Measurement of 10mm is a reasonable upper limit of normal in our environment. Foetuses with larger values need further evaluation to rule out hydrocephalus.

Detección ecográfica y pronóstico de la ventriculomegalia fetal / Ultrasound detection and prognosis of fetal ventriculomegaly

Antecedentes: La ventriculomegalia fetal es un signo ecográfico muy sensible para las alteraciones del sistema nervioso central fetal. La morbilidad asociada a la misma depende principalmente de la etiología y de la presencia de otras malformaciones asociadas. Si es aislada y no progresiva se puede preveer un resultado posnatal favorable hasta en el 70 por ciento de los casos aunque hay una gran disparidad de cifras entre distintos centros y autores. Objetivo: Establecer la relación entre ventriculomegalia y pronóstico perinatal. Método: Se han revisado 60 casos diagnosticados mediante ecografía prenatal en el Hospital Universitario de Canarias siguiendo los criterios ecográficos de ventriculomegalia (astas posteriores mayores de 10 mm). Se realizaron cariotipos y serología materna y en líquido amniótico para completar el estudio. Resultados: Hubo un total de 23 interrupciones voluntarias de la gestación y 28 recién nacidos sin secuelas (47 por ciento). Un 70 por ciento de las ventriculomegalias aisladas correspondieron a recién nacidos sin secuelas. El 10 por ciento de las ventriculomegalias aparecieron en fetos con aneuploidías. Conclusión: El pronóstico fue favorable en los casos de ventriculomegalia no progresiva y aislada. La medida de la ventriculomegalia no predice el resultado. La variabilidad de resultados en la literatura obliga a cada centro a disponer de sus protocolos y datos para aconsejar a la pareja que ha de tomar una decisión sobre el futuro de su embarazo.

Background: Fetal ventriculomegaly is the most sensitive sonographic sign for central nervous system anomalies. Neonatal morbidity and mortality depends on the etiology of the ventriculomegaly and the presence of other malformations. Isolated non-progressive ventriculomegaly is associated with 70 percent favorable results, with a great disparity among studies. Aims: To establish the relationships between ventriculomegaly and perinatal outcome. Methods: The authors reviewed 60 cases of prenatally diagnosed fetal ventriculomegaly in the Canary Islands University Hospital. An ultrasonographic measurement of the lateral ventricles of 10 mm or more was considered as ventriculomegaly. Fetal and maternal serology was performed as well as fetal karyotyping. Results: 23 patients decided to terminate the pregnancy due to unfavorable prognosis. In 28 cases outcome was favorable. 70 percent of isolated ventriculomegaly corresponded to healthy newborns. 10 percent of the fetuses had aneuploidies. Conclusion: Prognosis is favorable if ventriculomegaly is isolated and non-progressive. Measurement of the lateral ventricle does not predict outcome. Disparity of results in literature makes it necessary for each Hospital to rely on their own data and guidelines to assess parents on the fate of the pregnancy.

Observations on the Activation of Chronic Compensated Hydrocephalus in Adult Patients / 대한신경손상학회지

OBJECTIVE: There is a broad spectrum of compensated hydrocephalus. Various terms such as long-standing overt ventriculomegaly in adult (LOVA) has been coined, however, even such terms leave diverse aspect of this condition out of account. We have experienced compensated hydrocephalus cases which were considered to be activated after a long time period of quiescent state, and tried to compare their clinical characteristics with the relatively well described entity of LOVA. METHODS: We conducted a retrospective review of 206 patients who underwent ventriculoperitoneal shunt (VPS) between February 2001 and May 2012. Of these, 6 patients had chronic compensated hydrocephalus. The clinical and radiological characteristics are evaluated. RESULTS: Definite triventriculomegaly was observed in two patients. Macrocephaly was observed in two cases, one with aqueductal stenosis (AS), the other with unknown status of aqueduct. All of the cases with triventriculomegaly were normocephalic. Spinal causes were thought as aggravating factor in two. Two endoscopic third ventriculostomy and eight VPS were performed in five patients. Four patients responded well but one took a very complicated course. CONCLUSION: The relationships between macrocephaly, triventriculomegaly, and AS suggested in other studies were inconsistent. Blockage or narrowing of cerebrospinal fluid pathways were observed at various sites. Disturbances of spinal arachnoid pathways were related to the activation in some cases. Treatment is to be tailored individually considering various reigniting event. It is suggested that this entity is to be evaluated for better nomenclature reflecting diverse aspects of this condition. Further study is needed to elucidate underlying pathophysiology and effective management.

Absence of the Septum Pellucidum Associated with a Midline Fornical Nodule and Ventriculomegaly: A Report of Two Cases

We report two autopsy cases that revealed the partial absence of the septum pellucidum with ventriculomegaly. In each case, the brain showed mild dilatation of both frontal horns of the lateral ventricles, normal third and fourth ventricles and no aqueductal stenosis. The posterior portion of the septum pellucidum was absent and the fornices were fused in a single midline nodule, abnormally displaced to a caudal position and lodged in the foramina of Monro. The brain base showed no apparent abnormalities; the optic nerves were well developed. We conclude that the caudally displaced fornix in the absence of the septum pellucidum may have intermittently obstructed the foramina of Monro and induced mild ventriculomegaly.

Prenatal Diagnosis of Transient Abnormal Myelopoiesis in a Down Syndrome Fetus

We report a case of transient abnormal myelopoiesis in a Down syndrome fetus diagnosed at 28(+3) weeks of gestation that rapidly progressed to intrauterine death 10 days later. Fetal hepatosplenomegaly with cerebral ventriculomegaly, although not specific, may be a suggestive finding of Down syndrome with transient abnormal myelopoiesis. Prompt fetal blood sampling for liver function test and chromosomal analysis are mandatory for early detection and management.

A Fetus with Persistent Hyperextended Neck Complicated with Ventriculomegaly and Pulmonary Immaturity in Third Trimester / 대한주산의학회잡지

Hyperextended neck of the fetal head is among the various fetal attitudes detected by prenatal sonography. Various etiologies may lead to hyperextension of the fetal head, including fetal anomalies such as structural abnormalities, conjoined twins and fetal neck masses, nuchal cord and uterine factors such as leiomyoma and uterine malformations. The importance of the precise prenatal diagnosis of this condition relates not only to the delivery mode, but also to the detection of associated conditions, as noted above. We report a case of a fetus whose persistent hyperextended neck was detected by midtrimester sonography, and who later demonstrated ventriculomegaly and lung immaturity in the 3rd trimester.