Ventriculo‐amniotic shunting for severe fetal ventriculomegaly

摘要

Abstract Introduction Severe fetal cerebral ventriculomegaly, observed in about 1 in 1000 newborns, is associated with a high risk of perinatal death and neurodevelopmental delay in survivors. The objective of this study was to evaluate the efficiency of ventriculo‐amniotic shunting for drainage of severe fetal cerebral ventriculomegaly and the neurodevelopment of survivors at the age of 2?years. Material and methods This was a retrospective study of 44 fetuses with severe bilateral ventriculomegaly treated with ventriculo‐amniotic shunting in a tertiary fetal therapy center between 2010 and 2015. Results Shunt insertion was successfully carried out at a median gestational age of 25?weeks (range 20‐33?weeks). There were three fetal deaths within 24?hours of the procedure and 41 live births at a median gestational age of 37?weeks (range 28‐39?weeks). Neurodevelopment at 2?years of age was evaluated using the Bayley scale in the 38 survivors. In the 27 cases with isolated ventriculomegaly 19 (70.4%; 95% confidence interval [95% CI] 51.5%‐84.2%) had normal or mild neurodevelopmental delay and 8 (29.6%; 95% CI 15.6%‐48.5%) were moderately or severely delayed. In the 11 with non‐isolated ventriculomegaly 2 (18.2%; 95% CI 5.1%‐4.8%) had normal or mild neurodevelopmental delay and 9 (81.8%; 95% CI 52.3%‐94.9%) babies were moderately or severely delayed. Conclusions Ventriculo‐amniotic shunting is an option for the management of severe ventriculomegaly and results in normalization of the ventricular diameter. However, a high proportion of survivors have neurodevelopmental delay and the possible beneficial effect of ventriculo‐amniotic shunting needs to be assessed by randomized studies.