Peiro Jose L, Fabbro Mateus Dal
Cincinnati Fetal Center, The Center for Fetal and Placental Research, Pediatric General and Thoracic Surgery Division, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, 45229, USA.
University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA.
Childs Nerv Syst. 2020 Aug;36(8):1697-1712. doi: 10.1007/s00381-020-04738-9. Epub 2020 Jun 29.
Despite unfavorable outcomes during the early experience with in utero intervention for congenital hydrocephalus, improvements in prenatal diagnosis, patient selection, and fetal surgery techniques have led to a renewed interest in fetal intervention for congenital hydrocephalus. Research studies and clinical evidence shows that postnatal cerebrospinal fluid diversion to release intraventricular pressure and cerebral mantle compression usually arrives late to avoid irreversible brain damage. Make sense to decompress those lateral ventricles as soon as possible during the intrauterine life when hydrocephalus is antenatally detected. We present a historical review of research in animal models as well as clinical experience in the last decades, traveling until the last years when some research fetal therapy groups have made significant progress in recapitulating the prenatal intervention for fetuses with congenital obstructive hydrocephalus.
尽管在先天性脑积水宫内干预的早期经验中结果并不理想，但产前诊断、患者选择和胎儿手术技术的进步使得人们对先天性脑积水的胎儿干预重新产生了兴趣。研究和临床证据表明，出生后进行脑脊液分流以释放脑室内压力和缓解大脑皮质受压通常为时已晚，无法避免不可逆的脑损伤。因此，当产前检测到脑积水时，在宫内尽早对侧脑室进行减压是有意义的。我们对过去几十年动物模型研究以及临床经验进行了历史性回顾，一直追溯到近年来，一些胎儿治疗研究小组在对先天性梗阻性脑积水胎儿进行产前干预方面取得了重大进展。
