Abstract
Evaluation of in utero shunting for fetal ventriculomegaly requires an analysis of the ex utero treatment of a comparison population of infants with idiopathic aqueductal stenosis (IAS). In this study, 14 neonates with IAS were followed with detailed developmental assessment profiles for 18 months or longer. Using magnetic resonance imaging, the preoperative and postoperative frontal cortical mantle widths (FCMW) were determined for each patient. Four of 14 children demonstrated normal outcomes while 5 of 14 children showed abnormal outcomes. The remaining 5 children demonstrated minimally impaired outcomes. No child with a postoperative FCMW below 30 mm showed normal development on any scale, while all children with abnormal development demonstrated a postoperative FCMW of 21 mm or less. In conclusion, the prognosis for normal long-term neurodevelopment in infants with IAS, despite prompt ex utero treatment, is guarded; the majority of such children will show developmental delays of varying degreès. The FCMW serves as a reasonable prognostic indicator in this patient population.
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Amacher AL, Reid WD (1984) Hydrocephalus diagnosed prenatally. Outcome of surgical therapy. Child's Brain 11: 119–125
Avman N, Gökalp HZ, Arasil E, Kanpolat Y, Özkal E, Karacan I, Selcuki M (1984) Symptomatology, evaluation and treatment of aqueductal stenosis. Neurol Res 6: 194–198
Barkovich AJ, Newton TH (1989) MR of aqueductal stenosis: evidence of a broad spectrum of tectal distortion. AJNR 10: 471–476
Cagnoni G, Guizzardi G, Giardina F, Mennonna P (1986) Follow up and surgical considerations on a series of patients operated on for non tumoral aqueductal stenosis. J Neurosurg Sci 30: 77–80
Carteri A, Scanarini M (1986) ICP recording in non tumoral aqueductal stenosis. J Neurosurg Sci 30: 17–18
Clewell WH (1988) Congenital hydrocephalus: treatment in utero. Fetal Ther 3: 89–97
Clewell WH, Johnson ML, Meier PR, Newkirk JB, Zide SL, Hendee RW, Bowes WA, Hecht F, O'Keeffe D, Henry GP, Shikes RH (1982) A surgical approach to the treatment of fetal hydrocephalus. N Engl J Med 306: 1320–1325
Dennis M, Fitz CR, Netley CT, Sugar J, Harwood-Nash DCF, Hendrick EB, Hoffman HJ, Humphreys RP (1981) The intelligence of hydrocephalic children. Arch Neurol 38: 607–615
Foltz EL, Shurtleff DB (1963) Five-year comparative study of hydrocephalus in children with and without operation (133 cases). J Neurosurg 36: 1064–1079
Frigoletto FD, Birnholz JC, Green MF (1982) Antenatal treatment of hydrocephalus by ventriculoamniotic shunting. JAMA 248: 2496–2497
Giuffrè R, Palma L, Fontana M (1986) Infantile nontumotal aqueductal stenosis. J Neurosurg Sci 30: 41–46
Hanigan WC (1991) The dilemma of fetal ventriculomegaly: research and therapy during the past decade. Perspect Neurol Surg 2: 111–123
Harrison MR, Filly RA, Golbus MS, Berkowitz RL, Callen PW, Canty TG, Catz C, Clewell WH, Depp R, Edwards MS, Fletcher JC, Frigoletto FD, Garrett WJ, Johnson ML, Jonsen A, De Lorimier AA, Liley WA, Mahoney JH, Manning FD, Meier PR, Michejda M, Nakayama DK, Nelson L, Newkirk JB, Pringle K, Rodeck C, Rosen MA, Schulman JD (1982) Fetal treatment. N Engl J Med 307: 1651–1652
Hirsch JF, Hirsch E, Sainte Rose C, Renier D, Pierre-Kahn A (1986) Stenosis of the aqueduct of Sylvius. Etiology and treatment. J Neurosurg Sci 30: 29–39
Jellinger G (1986) Anatomopathy of non-tumoral aqueductal stenosis. J Neurosurg Sci 30: 1–16
Lee BCP (1987) Magnetic resonance imaging of peri-aqueductal lesions. Clin Radiol 38: 527–533
Lobato RD, Lamas E, Esparza J (1980) Intraventricular pressure monitoring and CSF dynamics in non-tumor aqueducral stenosis. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwald GM, Brock M (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 511–515
Manning FA, Harrison MR, Rodeck C (1986) Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry. N Engl J Med 315: 336–340
McCullough DC, Balzer-Martin LA (1982) Current prognosis in overt neonatal hydrocephalus. J Neurosurg 57: 378–383
Mealey J, Gilmor RL, Bubb MP (1973) The prognosis of hydrocephalus overt at birth. J Neurosurg 39: 348–355
Novetsky GJ, Berlin L (1984) Aqueductal stenosis: demonstration by MR imaging. J Comput Assist Tomogr 8: 1170–1171
Pringle KC (1989) Fetal diagnosis and fetal surgery. Clin Perinatol 16: 13–22
Robertson IJA, Leggate JRS, Miller JD, Steers AJW (1990) Aqueduct stenosis-presentation and prognosis. Br J Neurosurg 4: 101–106
Shurtleff DB, Foltz EL, Loeser JD (1973) Hydrocephalus. A definition of its progression and relationship to intellectual function, diagnosis, and complications. Am J Dis Child 125: 688–693
Venes JL (1983) Management of intrauterine hydrocephalus. J Neurosurg 58: 793
Yashon D, Jane JA, Sugar O (1965) The course of severe untreated infantile hydrocephalus. Prognostic significance of the cerebral mantle. J Neurosurg 23: 509–516
Young HF, Nulsen FE, Weiss MH, Thomas P (1973) The relationship of intelligence and cerebral mantle in treated infantile hydrocephalus (IQ potential in hydrocephalic children). Pediatrics 52: 38–44
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Hanigan, W.C., Morgan, A., Shaaban, A. et al. Surgical treatment and long-term neurodevelopmental outcome for infants with idiopathic aqueductal stenosis. Child's Nerv Syst 7, 386–390 (1991). https://doi.org/10.1007/BF00304203
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DOI: https://doi.org/10.1007/BF00304203