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.

Clinical outcome of prenatally diagnosed isolated fetal ventriculomegaly: retrospective analysis of 175 cases / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the natural course, postnatal outcome, and association between the degree of ventriculomegaly and neurodevelopmental delay in isolated fetal ventriculomegaly. METHODS: We reviewed the medical records of pregnant women diagnosed with isolated fetal ventriculomegaly from October 1996 to June 2004. We defined mild ventriculomegaly as atrial width of 10-14.9 mm and overt ventriculomegaly as 15 mm or more. Neonatal brain ultrasonography was performed in all cases and brain MRI was performed as necessary. Neurodevelopmental outcome was evaluated by medical records and telephone interviews. We analyzed the final outcome of isolated fetal ventriculomegaly according to the ventricular width. RESULTS: There were 175 cases of isolated fetal ventriculomegaly, with a large proportion of male fetuses (68.6%), and one case of trisomy 21. While the group with prenatally resolved ventriculomegaly (n=119) had a smaller ventricular width and more unilaterality, there was no resolution in cases with a ventricular width of 15 mm or more. One hundred and thirty one fetuses with an initial ventricular width of 10 to 11.9 mm had no developmental delay, however, there were 2 cases of cerebral palsy and 2 cases of genetic disorder. Seventeen fetuses had ventricular dilatation of 15 mm or more, with 6 corresponding cases of developmental delay and one case of cerebral palsy. CONCLUSION: Among isolated fetal ventriculomegaly, mild, unilateral or stable ventriculomegaly seems to have a favorable neurological outcome, especially those cases with ventricular width of less than 12 mm. However, management of the condition and counseling of parents are still crucial, because it can be a marker of genetic disorder or brain developmental delay.

Ultrasonographic indicators in predicting postnatal outcomes of antenatally detected ventriculomegaly / 대한산부인과학회지

OBJECTIVE: The aim of this study was to find out the prognostic indicators of antenatally detected ventriculomegaly. METHODS: During the study period (Nov. 1995 through Jan. 2003), we identified 96 cases of fetal ventriculomegaly and reviewed their antenatal and postnatal follow-up records retrospectively. Excluding cases of termination before viable stage and incomplete follow-up, 68 cases were evaluated. Severe ventriculomegaly (fetal hydrocephalus; n=30) was defined as lateral ventricular atrial width (LVAW) greater than 15 mm, and mild ventriculomegaly (n=38) was defined as LVAW between 10 and 15 mm. Subgroup of LVAW <12 mm (n=23) was also analyzed. Antenatal workup included detailed ultrasonography, TORCH test and karyotyping. Outcome parameters were the presence of progressive lesion, NICU admission, shunt operation and critical damage that included delayed development, cerebral palsy and death after live birth. RESULTS: Overall survival rate was 89.7% (61/68) and the median postnatal follow-up duration was 17.0 (0.0-69.3) months. Severe ventriculomegaly group showed higher incidence of progressive lesion, NICU admission and shunt operation than did mild group. Within mild ventriculomegaly group, critical damage was more common in cases with associated anomalies, and this difference was present even in the subgroup of LVAW <12 mm (2/16 vs. 4/7, p<0.05). CONCLUSION: In mild ventriculomegaly group, comprehensive antenatal workup including detailed ultrasonography is important because associated anomaly is a poor prognostic factor, even in cases of LVAW <12 mm. In terms of critical damage such as developmental delay, cerebral palsy and postnatal death, the prognosis of cases with mild ventriculomegaly is also guarded.