Diagnosis and Treatment of Fetal Hydrocephalus

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Abstract
Since the development of diagnostic procedures for fetal congenital anomalies, active trials of surgical approaches during fetal life have been carried out. However, evaluation of the fetal hydrocephalic state, apart from assessing the size of enlarged ventricles, is limited at present. Determining the surgical indication for shunt during fetal life is probably the most difficult problem in the management of fetal hydrocephalus. Familial cases of fetal hydrocephalus diagnosed in the fetal stage are presented and the surgical indications for in utero treatment are discussed. In these cases, whole body computerized tomography (CT) in the third trimester was found to be more useful than ultrasound for evaluation of the hydrocephalic state. They received ventriculo-peritoneal shunt operation immediately after birth and did fairly well, showing normal development and rapid cerebral reconstitution in followup CT. Congenital hydrocephalus children are analyzed in light of the relationship between the period of increased intracranial pressure before the shunt operation and the mental outcome. Analysis of 24 cases showed that all with intelligence quotient (IQ) of more than 80 had their initial shunt operation within 60 days after noting the first sign of increased intracranial pressure, whereas of the patients with an IQof below 20, only five dysraphic patients received the shunt operation within 40 days. These five patients had a poor outcome in their IQ scale despite early treatment. Thus, only 5 out of the 24 patients (20.8%) had the possibility of an irreversible change of their hydrocephalic state during the fetal stage. It was suggested that fetal hydrocephalus cases actually requiring early treatment, i.e., intrauterine shunt procedure, were relatively few, the majority doing well with the regular management of infantile hydrocephalus. Early treatment is the ideal in the management of congenital hydrocephalus, but there are unsolved problems, including the selection of cases and the necessity for technical improvements in the present shunt procedure for fetal hydrocephalus.

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