Fetal hydrocephalus--prenatal treatment

Abstract

Patients and methods: From January 1986 to January 2001, 85 cases of hydrocephalus were referred to the Pediatric Neurosurgery and Fetal Medicine Sections of the São Paulo Federal University and the Santa Joana Maternity Hospital in São Paulo, Brazil. Thirty-nine of these cases concerned fetuses ranging from 24 to 32 weeks' gestation, who underwent intrauterine treatment. The hydrocephalus etiologies consisted of: aqueduct stenosis (18 cases), intraventricular hemorrhage (8 cases), Dandy-Walker malformation (4 cases), Chiari type II (4 cases), and other diverse etiologies (5 cases). Twenty fetuses underwent repeated cephalocentesis: 18 received a ventriculo-amniotic shunt and in 1 case endoscopic third ventriculostomy was performed. The follow-up period varied between 1 and 14 years (median 5 years). Out of 39 patients, 26 have been considered as normal (IQ above 70), 6 have mild or moderate handicaps (IQ from 35 to 70), and 7 are severely handicapped (IQ below 35). After birth, 38 patients underwent ventriculoperitoneal shunting with low-pressure valves.

Conclusion: In the absence of chromosomopathies, when the gestational age ranges between 24 and 32 weeks, progressive fetal hydrocephalus of a non-infectious origin can obtain benefit from intraventricular decompression performed during the fetal period. New methods of diagnosis and treatment should be developed, especially in those countries where interruption of gestation is not permitted by law, for the benefit of those families who, due to social or religious factors, do not accept abortion.