In utero surgery for hydrocephalus.
BACKGROUND
Neonatal hydrocephalus is one of the most common congenital anomalies affecting the nervous system.


CONCLUSIONS
Currently, ultrasonography allows for early detection of fetal ventriculomegaly and presents the family with several treatment options: termination of pregnancy, early delivery and neonatal shunting, and delivery at term followed by shunting. Despite ventricular decompression after birth, the cognitive outcome is variable as prolonged in utero hydrocephalus has a detrimental effect. In the early 1980s, fetal intervention was explored with the intention of improving outcome. However, patient selection was poor. Fetal ventriculomegaly from other conditions was not adequately distinguished from fetal hydrocephalus. In addition, fetal surgical techniques were not advanced. Consequently, the results were poor and a de facto moratorium on fetal shunting was imposed. However, recent improvements in fetal imaging, such as magnetic resonance imaging, and advances in fetal surgical techniques offer the possibility that properly selected fetuses with hydrocephalus can benefit from an in utero intervention.
von Koch
Cornelia S
CS
Department of Neurological Surgery, University of California San Francisco, Room M-779, 505 Parnassus Avenue, Box 0112, San Francisco, CA 94143-0112, USA. vonkochc@neurosurg.ucsf.edu
Gupta
Nalin
N
Sutton
Leslie N
LN
Sun
Peter P
PP
D000818:Animals; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D004195:Disease Models, Animal; D005314:Embryonic and Fetal Development; D005260:Female; D005315:Fetal Diseases / Q000473:pathology / Q000601:surgery*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D006849:Hydrocephalus / Q000145:classification / Q000175:diagnosis / Q000266:history / Q000601:surgery*; D007427:Intracranial Pressure; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods