Morioka Takato, Hashiguchi Kimiaki, Nagata Shinji, Miyagi Yasushi, Mihara Futoshi, Hikino Shunji, Tsukimori Kiyomi, Sasaki Tomio
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Pediatr Neurosurg. 2006;42(6):354-61. doi: 10.1159/000095565.
Subependymal germinal matrix with intraventricular hemorrhage (GMIVH) is a common complication associated with delivery in preterm neonates but has rarely been observed in the fetus. Clinical and neuroradiological findings of 5 patients who were diagnosed as having fetal GMIVH with prenatal ultrasonographic examinations (US) and MRI, and postnatal MRI were reviewed retrospectively. During a seemingly uneventful pregnancy, fetal GMIVH occurred at approximately 30-33 weeks of gestation, with the absence of any known factor predisposing to fetal hemorrhage. Routine obstetric US revealed an intraventricular lesion in the enlarged ventricles. Prenatal MRI clearly demonstrated parenchymal change such as intracerebral hematoma adjacent to the subependymal and intraventricular hematoma, and periventricular leukomalacia as well as GMIVH. Although patients without parenchymal destruction (hemosiderin deposit alone) had a favorable neurodevelopmental outcome, encephalomalacia and periventricular leukomalacia contributed to long-term neurodevelopmental deficits. Evaluating parenchymal damage with prenatal MRI can therefore help to predict neurodevelopmental prognosis of the fetus with GMIVH.
室管膜下生发基质伴脑室内出血（GMIVH）是早产儿分娩相关的常见并发症，但在胎儿中很少见。回顾性分析了5例经产前超声检查（US）和MRI以及产后MRI诊断为胎儿GMIVH患者的临床和神经放射学表现。在看似正常的妊娠期间，胎儿GMIVH发生在妊娠约30 - 33周，且不存在任何已知的易导致胎儿出血的因素。常规产科超声检查发现扩大的脑室内有病变。产前MRI清楚地显示了实质改变，如室管膜下和脑室内血肿相邻的脑内血肿、脑室周围白质软化以及GMIVH。虽然没有实质破坏（仅含铁血黄素沉积）的患者神经发育结局良好，但脑软化和脑室周围白质软化导致了长期的神经发育缺陷。因此，通过产前MRI评估实质损伤有助于预测患有GMIVH的胎儿的神经发育预后。
