Perinatal ventriculomegaly

Article type: Research Article

Authors: Hassanein, Sahar M.A. | Moharram, Husein | Monib, Ahmed Mohamed | Ramy, Ahmed R.M.R.A. | Ghany, Walid Abdel

Affiliations: Department of Pediatrics, Ain Shams University Hospital, Cairo, Egypt | Department of Neurosurgery, Ain Shams University Hospital, Cairo, Egypt | Department of Radiodiagnosis, Ain Shams University Hospital, Cairo, Egypt | Department of Obstetrics and Gynecology, Ain Shams University Hospital, Cairo, Egypt

Note: [] Correspondence: Sahar M.A. Hassanein, Department of Pediatrics, Ain Shams University Hospital, Cairo, Egypt. Tel.: +20 1 23183943; Fax: +20 2 26820237; E-mail: saharhassanein@yahoo.com

Abstract: Ventriculomegaly is an increase in cerebral ventricular dimensions. It could be secondary to increased cerebrospinal fluid pressure in the ventricular cavity (hydrocephalus), or to a lack of brain parenchyma due to atrophic involution or arrested development. Ventriculomegaly causes diagnostic, therapeutic, and prognostic dilemma for obstetricians, neonatologists, and neurosurgeon. Mild fetal cerebral ventriculomegaly or borderline ventriculomegaly is defined as an axial diameter > 10 mm across the atrium of the posterior or anterior horn of lateral ventricles at any gestation. Moderate ventriculomegaly is atrial diameter larger than 15 mm; residual cortex larger than two mm in diameter and severe (atrial diameter larger than 15 mm and residual cortex smaller than two mm in diameter). Sonographic demonstration of adducted thumbs in combination with ventriculomegaly and other intracranial abnormalities should prompt the diagnosis of X-linked hydrocephalus spectrum. Fetal brain magnetic resonance imaging, echocardiography, abdominal ultrasonography, karyotype, and serologic tests for congenital infections are indicated. Neonatal ventriculomegaly could be just due to increased width of cerebral ventricles or increased cerebrospinal fluid volume i.e. hydrocephalus. Hydrocephalus could be obstructive (non-communicating) hydrocephalus or non-obstructive (communicating). Also, hydrocephalus course could be active (decompensated or progressive) or compensated (arrested). Intraventricular hemorrhage is the most common cause of acquired hydrocephalus (post-hemorrhagic hydrocephalus) in preterm neonates. Progressive hydrocephalus is associated with head circumference, crossing centile lines or expanding at over 1.5–2 mm/day, a tense anterior fontanel and separation of the cranial sutures, apnea, vomiting, and abnormal posture. Prevention and management of post-hemorrhagic hydrocephalus is very challenging. Shunt operation is the definitive treatment of progressive hydrocephalus due to any cause.

Keywords: Aqueduct stenosis, CNS malformations, fetal, hydrocephalus, intraventricular hemorrhage, meningomyelocele, neonatal, perinatal, post-hemorrhagic hydrocephalus, post-hemorrhagic ventricular dilatation, ventriculomegaly

Journal: Journal of Pediatric Neurology, vol. 6, no. 4, pp. 293-307, 2008