Skip to main content
SpringerLink
Log in
Book cover

Hydrocephalus pp 357–369Cite as

Surgical Management of Fetal Hydrocephalus

  • Chapter
  • First Online:

  • 1219 Accesses

Abstract

Hydrocephalus is an abnormal accumulation of cerbrospinal fluid (CSF) resulting to enlargement of the ventricular system where intracranial pressure is frequently elevated. Neonatal hydrocephalus is one of the most common central nervous system (CNS) congenital anomalies in the world.

The big difference between a hydrocephalic fetus and a hydrocephalic neonate is that, in the former case, it is the mother—fetus binomial—that is involved. No matter what procedure should be performed, it is the mother that should be taken into consideration. From the simple natural childbirth to the most complex prenatal neurosurgical procedures, whenever hydrocephaly is to be treated during the fetal period, the mother will have to face some risks involving ethical, religious, and socioeconomical problems that normally do not exist for the newborn infant. Another essential factor concerns prematurity. The decision to induce labor and treat the hydrocephalus cannot be complicated with prematurity problems. It is up to the neurosurgeon to choose the best moment for delivery, considering both the hydrocephalus degree and the risks of prematurity. The best overall results in fetal surgery have been those obtained in cases of acute obstructive hydrocephalus having developed no earlier than the third trimester of gestation and were not associated with any other malformation (Kirkinen et al., Ann Med 28:131–6, 1996). Knowledge about both diagnosis and treatment of this serious type of hydrocephalus can be still improved in health centers specialized in fetal medicine.

This is a preview of subscription content, log in via an institution.

References

  1. Sutten L, Sun P, Adsick S. Fetal neurosurgery. Neurosurgery. 2001;48:124–44.

    Google Scholar 

  2. Bruner J, Davis G, Tulipan N. Intrauterine shunt for obstructive hydrocephalus—still not ready. Fetal Diagn Ther. 2006;21:532–9.

    Article  PubMed  Google Scholar 

  3. Al-Anazi AR, Nasser MJ. Hydrocephalus in the Eastern province of Saudi Arabia. Qatar Med J. 2003;12:133–5.

    Google Scholar 

  4. El-Awad ME. Infantile hydrocephalus in south-western region of Saudi Arabia. Ann Trop Paediatr. 1992;12:119–23.

    Google Scholar 

  5. Murshid W, Imma Dad M, Jarallah J. Epidemiology of infantile hydrocephalus in Saudi Arabia: birth prevalence and associated factors. Pediatr Neurosurg. 2003;32:119–23.

    Article  Google Scholar 

  6. Cherwenak FA, Duncan C, Ment LR, et al. Outcome of fetal ventriculomegaly. Lancet. 1984;2:179–81.

    Article  Google Scholar 

  7. Nyberg DN, Mac LA, Hirch J, et al. Fetal hydrocephalus. Radiology. 1987;163:187–91.

    Article  CAS  PubMed  Google Scholar 

  8. Oi L, Honda Y, Hidaka M, et al. Intrauterine high-resolution magnetic resonance imaging in fetal hydrocephalus and prenatal estimation of postnatal outcomes with “perspective classification”. J Neurosurg. 1998;88:685–94.

    Article  CAS  PubMed  Google Scholar 

  9. Kirkinen P, Partanen K, Vainio P, et al. MRI in obstetrics: a supplementary method for ultrasonography. Ann Med. 1996;28:131–6.

    Article  CAS  PubMed  Google Scholar 

  10. Benacerraf BR, Shipp TD, Bromley BR, Levine D. What does magnetic resonance imaging add to the prenatal sonographic diagnosis of ventriculomegaly? J Ultrasound Med. 2007;26:1513–22.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dill P, Poretti A, Boltshauser E, Huisman TA. Fetal magnetic resonance imaging in midline malformations of the central nervous system and review of the literature. J Neuroradiol. 2009;36:138–46.

    Article  CAS  PubMed  Google Scholar 

  12. Jeanty P, Dramaix-Wilmet M, Delbeke D, Rodesch F, Struyven J. Ultrasonic evaluation of fetal ventricular growth. Neuroradiology. 1981;21:127–31.

    CAS  PubMed  Google Scholar 

  13. Leidig E, Dannecker G, Pefeifer KH, Salinas R, Pfeifer G. Intrauterine development of posthaemorrhagic hydrocephalus. Eur J Pediatr. 1988;147:26–9.

    Article  CAS  PubMed  Google Scholar 

  14. Levine D, Trop I, Mehta TS, Barnes PD. MR imaging appearance of fetal cerebral ventricular morphology. Radiology. 2002;223:652–60.

    Article  PubMed  Google Scholar 

  15. Manning FA, Harrison MR, Rodeck C, Members of the International Fetal Medicine and Surgery Society. Catheter shunts for fetal hydronephrosis and hydrocephalus: report of the international fetal surgery registry. N Engl J Med. 1986;315:336–40.

    Article  CAS  PubMed  Google Scholar 

  16. Chervenak FA, Ment LR, McClure M, Berkowitz RL, Duncan C, Hobbins C, Scott D. Outcome of fetal ventriculomegaly. Lancet. 1984;2:179–81.

    Article  CAS  PubMed  Google Scholar 

  17. Clark RG, Milhorat TH. Experimental hydrocephalus—light microscopic findings in acute and subacute obstructive hydrocephalus in the monkey. J Neurosurg. 1970;32:400–13.

    Article  CAS  PubMed  Google Scholar 

  18. Edwards MSD, Harrison MR, Halks-Miller M, Nakayama DK, Berger MS, Glick PL, Chinn DH. Kaolin induced congenital hydrocephalus in utero in fetal lambs and rhesus monkeys. J Neurosurg. 1984;60:115–22.

    Article  CAS  PubMed  Google Scholar 

  19. Stein SC, Feldman JG, Apfel S, Kolh SG, Casey G. The epidemiology of congenital hydrocephalus. A study in Brooklyn, N.Y. 1968–1976. Childs Brain. 1981;8:253–62.

    CAS  PubMed  Google Scholar 

  20. Cavalheiro S, Moron AF, Zymberg ST, Dastoli P. Fetal hydrocephalus—prenatal treatment. Childs Nerv Syst. 2003;19:561–73.

    Article  PubMed  Google Scholar 

  21. Hoffman-Tretin JC, Horoupian DS, Koenigsberg M, Schnur MJ, Llena JR. Lobar holoprosencephaly with hydrocephalus: antenatal demonstration and differential diagnosis. J Ultrasound Med. 1986;5:691–7.

    Article  CAS  PubMed  Google Scholar 

  22. Bronshtein M, Zimmer E, Greshonu-Baruch R, Yoffe N, Meyer H, Blumenfield Z. First and second trimester diagnosis of fetal ocular defects and associated anomalies: report of eight cases. Obstet Gynecol. 1991;77:443–9.

    Google Scholar 

  23. Patten RM, Mack LA, Finberg HJ. Unilateral hydrocephalus: prenatal sonographic diagnosis. AJR Am J Roentgenol. 1991;156:359–63.

    Article  CAS  PubMed  Google Scholar 

  24. McGahan JP, Haesslein HC, Meyers M, Ford KB. Sonographic recognition of in utero intraventricular hemorrhage. AJR Am J Reontgenol. 1984;142:171–3.

    Article  CAS  Google Scholar 

  25. Hanigan WC, Gibson J, Kelopoulos NJ, Cusack T, Zwicky G, Wright RM. Medical imaging of fetal ventriculomegaly. J Neurosurg. 1986;64:575–80.

    Article  CAS  PubMed  Google Scholar 

  26. Montegudo A, Reuss L, Tiomr-Tritsch IE. Imaging the fetal brain in the second and third trimester using transvaginal sonography. Annu Rev Hydroceph. 1992;10:53s55.

    Google Scholar 

  27. Clark SL, deVore GR, Sabey P. Prenatal diagnosis of cysts of the choroid plexus. Obstet Gynecol. 1988;72:585–7.

    CAS  PubMed  Google Scholar 

  28. Oi S, Matsumoto S, Katayama K, Mochizuki M. Prenatal neuroimaging in fetal dysraphism. Neurosonology. 1990;3:90–6.

    Article  Google Scholar 

  29. Oi S, Sato O, Matsumoto S. A new classification for congenital hydrocephalus and postnatal prognosis (Part I). A proposal of a new classification of fetal/neonatal/infantile hydrocephalus based on neuronal maturation process and chronological changes. Jpn J Neurosurg (Tokyo). 1994;3:122–7.

    Article  Google Scholar 

  30. Oi S, Matsumoto S, Katayama K, Mochizuki M. Pathophysiology and postnatal outcome of fetal hydrocephalus. Childs Nerv Syst. 1990;6:338–45.

    Article  CAS  PubMed  Google Scholar 

  31. Michejda M, Queenan JT, McCullough D. Present status of intrauterine treatment of hydrocephalus and its future. Am J Obstet Gynecol. 1986;155:873–82.

    Article  CAS  PubMed  Google Scholar 

  32. Shapiro K, Fred F, Marmarou A. Biomechanical and hydrodynamic characterization of hydrocephalic infant. J Neurosurg. 1985;63:69–75.

    Article  CAS  PubMed  Google Scholar 

  33. Clewell WH, Johnson ML, Meier RP, et al. A surgical approach to the treatment of fetal hydrocephalus. N Engl J Med. 1982;306:1320–5.

    Article  CAS  PubMed  Google Scholar 

  34. Thickman D, Mints M, Mennuti M, Kressel HY. MR imaging of cerebral abnormalities in utero. J Comput Assist Tomogr. 1984;8:1058–61.

    Article  CAS  PubMed  Google Scholar 

  35. Oi S. Classification of hydrocephalus: critical analysis of classification categories and advantages of “Multi-categorical hydrocephalus classification” (Mc HC). Childs Nerv Syst. 2011;27:1523–33.

    Article  PubMed  Google Scholar 

  36. Oi S. Hydrocephalus research update: controversies in definition and classification of hydrocephalus. Neurol Med Chir (Tokyo). 2010;50:859–69.

    Article  Google Scholar 

  37. Hippocrates: De Morbis. Cited by Whytt R: observations on the dropsy in the brain. Edinburgh: Balfour; 1768. p. 4.

    Google Scholar 

  38. Davidoff LE. Treatment of hydrocephalus. Arch Surg. 1929;18:1737–62.

    Article  Google Scholar 

  39. Drake JM, Sainte-Rose C. The shunt book. Cambridge: Blackwell Science; 1995. p. 3–12.

    Google Scholar 

  40. Bors E. Bie methodic der intrauterine operation am uberlebenden saugerties foetus. Arch EntwckIngsmechn. Organ. 1925;105:655–66.

    Google Scholar 

  41. Barron D. An experimental analysis of some factors involved in the development of the fissure pattern of the cerebral cortex. J Exp Zool. 1950;113:553–81.

    Article  Google Scholar 

  42. Hooker D, Nicholas J. Spinal cord section in rat fetuses. J Comp Neurol. 1930;50:413–67.

    Article  Google Scholar 

  43. Nakayama DK, Harrison MR, Berger MS, et al. Correction of congenital hydrocephalus in utero: part I- the model: intracisternal kaolin produces hydrocephalus in fetal lambs and rhesus monkeys. J Pediatr Surg. 1983;18:331338.

    Google Scholar 

  44. Rakic P, Goldman-Rakic P. Use of fetal neurosurgery for experimental studies of structural and functional brain development in non-human primates. In: Perinatal neurology and neurosurgery. New York: SP Medical and Scientific Books; 1985. p. 1–15.

    Google Scholar 

  45. Clewell WH, Johnson ML, Meier PR, et al. A surgical approach to the treatment of fetal hydrocephalus. N Engl J Med. 1982;306:1820–5.

    Article  Google Scholar 

  46. Micheida M. Intrauterine treatment of hydrocephalus. Fetal Ther. 1986;1:75–9.

    Article  Google Scholar 

  47. Reynolds J, Pernoll M, Gill W, et al. A case of ventricular-amniotic shunting. South Med J. 1985;78:203–5.

    Article  CAS  PubMed  Google Scholar 

  48. Ammar A, Rahman S, Anazi AR, Muazen Y, Sibai H. Prolonged intrauterine transabdominal ventricular external drainage. A method to decompress dilated fetal ventricles. Minim Invasive Neurosurg. 1996;39:1–3.

    Article  CAS  PubMed  Google Scholar 

  49. Harrison MR, Filly RA, Golbus MS, et al. Fetal treatment. N Engl J Med. 1982;307:651–2.

    Article  Google Scholar 

  50. Cavalheiro S, Fernandes AM, Almodin CG, et al. Fetal hydrocephalus. Childs Nerv Syst. 2011;27:1575–83.

    Article  PubMed  Google Scholar 

  51. Al-Anazi A. Novel shunt device for intrauterine treatment of hydrocephalus. Pan Arab J Neurosurg. 2007;11:37–40.

    Google Scholar 

  52. Al-Anazi AR, Al-Mejhim F, Al-Qahtani N. In-utero ventriculoamniotic shunt for hydrocephalus. Childs Nerv Syst. 2008;24:193–5.

    Article  PubMed  Google Scholar 

  53. Al-Anazi AR. In-utero ventriculouterine shunt treatment of fetal hydrocephalus: preliminary study of Al-Anazi ventriculouterine shunt. Neurosurg Q. 2010;20:1–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia

    Abdulrahman Al Anazi

Authors
  1. Abdulrahman Al Anazi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abdulrahman Al Anazi .

Editor information

Editors and Affiliations

  1. Dammam University, King Fahd University Hospital Dammam University, Al Khobar, Saudi Arabia

    Ahmed Ammar

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Al Anazi, A. (2017). Surgical Management of Fetal Hydrocephalus. In: Ammar, A. (eds) Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-61304-8_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61304-8_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61303-1

  • Online ISBN: 978-3-319-61304-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation