Correlation between ventriculomegaly on prenatal magnetic resonance imaging and the need for postnatal ventricular shunt placement.
OBJECTIVE
Pediatric neurosurgeons are increasingly called on to provide prognostic data regarding the antenatal diagnosis of ventriculomegaly. This study was designed to determine if there is a correlation between prenatal MR imaging results and the need for ventricular shunt placement during the neonatal period.


METHODS
The authors retrospectively reviewed the prenatal MR imaging data of 38 consecutive patients who had been referred for neurosurgical consultation following the diagnosis of ventriculomegaly. The outcome measure was placement of a ventricular shunt. Assessed parameters included prenatal atrial diameter (AD), gestational age at MR imaging, time between imaging studies, presence of concomitant CNS anomalies, laterality of ventriculomegaly, fetal sex, and temporal evolution of ventriculomegaly. Logistic regression analysis was completed with the calculation of appropriate ORs and 95% CIs.


RESULTS
Six patients (16%) required shunt placement, all with an AD > or = 20 mm (mean 23.8 mm) at the time of imaging. Eight patients had presented with an AD > or = 20 mm. Atrial diameter was the only presenting feature that correlated with shunt placement (OR 1.58, 95% CI 1.10-2.25, p = 0.01). Logistic regression analysis revealed no statistical correlation between the need for ventricular shunting and gestational age at MR imaging, time between imaging studies, fetal sex, presence of additional CNS anomalies, and laterality of the ventriculomegaly.


CONCLUSIONS
When assessed using MR imaging, an AD > or = 20 mm at any gestational age is highly associated with the need for postnatal shunting. Patients with concomitant CNS anomalies did not require shunts at a greater rate than those with isolated ventriculomegaly. Further studies are required to assess the long-term outcome of this patient population.
Hankinson
Todd C
TC
Department of Neurosurgery, Columbia University, New York, New York 10032, USA. tch12@columbia.edu
Vanaman
Monique
M
Kan
Peter
P
Laifer-Narin
Sherelle
S
Delapaz
Robert
R
Feldstein
Neil
N
Anderson
Richard C E
RC
D000015:Abnormalities, Multiple / Q000175:diagnosis; D001921:Brain / Q000002:abnormalities*; D002552:Cerebral Ventricles / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D017287:Ventriculoperitoneal Shunt