"Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.
Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France.
Childs Nerv Syst. 2021 Nov;37(11):3417-3428. doi: 10.1007/s00381-021-05217-5. Epub 2021 Jun 2.
Hydrocephalus is commonly associated with myelomeningocele (MMC). Indication and timing of cerebrospinal fluid (CSF) shunting are still a topic of discussion. The aim of this study was to investigate whether the analysis of prenatal cerebral imaging studies could provide information that is predictive of the necessity of CSF shunting in the postnatal period.
Among 73 infants operated on because of MMC between January 2003 and June 2020, 50 had undergone prenatal and postnatal MRI studies and were considered for analysis. For each patient, frontal horn width, atrial ventricle diameter, third ventricle diameter, and subarachnoid spaces (sinocortical width, craniocortical width, and the interhemispheric width) have been measured on prenatal, postnatal, and a follow-up MRI study. The need of CSF shunting device placement in relation to prenatal and early postnatal MRI data was investigated.
Of the 50 infants, 31 (62%) developed a progressive hydrocephalus. Of these, 30 needed a CSF shunt and the majority of them (n=29) was operated on within 28 days after birth. One patient needed CSF shunt implantation at 45 days after birth and one child developed a late progressive hydrocephalus, successfully treated by ETV alone, at 14.2 months of age. All patients with an atrial ventricle diameter greater than 1.9 cm and a 3rd ventricle diameter larger than 0.3 cm on antenatal third trimester imaging have undergone CSF shunting within 1 month after birth. Conversely, all the children that did not undergo a CSF shunt placement showed an atrial cerebral ventricle diameter inferior to 1.2 cm and a 3rd ventricle width < 0.3 cm on antenatal imaging. Frontal horn width and subarachnoid CSF spaces' evolution did not seem to play a role.
The prenatal MRI assessment of the associated prenatal ventriculomegaly in MMC provides parameters that have a predictive value heralding the probability of a CSF diversion procedure after birth. In the same way, the analysis of intrauterine MRI studies may identify those subjects that are less at risk of developing a progressive hydrocephalus after birth, therefore encouraging a more cautious attitude towards the early implantation of CSF shunting devices in the current clinical practice.
脑积水通常与脊髓脊膜膨出（MMC）有关。脑脊液（CSF）分流的适应证和时机仍存在争议。本研究旨在探讨产前脑影像学研究是否能提供与新生儿期 CSF 分流必要性相关的信息。
2003 年 1 月至 2020 年 6 月间，73 例因 MMC 而接受手术的患儿中，50 例行产前和产后 MRI 研究，被认为适合进行分析。对每位患儿，分别测量产前、产后和随访 MRI 研究中的侧脑室额角宽度、房室（atrial ventricle）直径、第三脑室直径以及蛛网膜下腔（sinocortical width，颅皮质宽度和半球间宽度）。研究分析了与产前和早期产后 MRI 数据相关的 CSF 分流装置放置的必要性。
50 例患儿中，31 例（62%）出现进行性脑积水。其中 30 例需要 CSF 分流，其中大多数（n=29）在出生后 28 天内进行手术。1 例患儿在出生后 45 天需要 CSF 分流植入，1 例患儿在 14.2 个月时出现迟发性进行性脑积水，仅通过 ETV 成功治疗。所有在产前晚期第三孕期影像学检查中房室直径大于 1.9cm 和第三脑室直径大于 0.3cm 的患儿均在出生后 1 个月内进行 CSF 分流。相反，所有未进行 CSF 分流的患儿在产前影像学检查中均显示房室直径小于 1.2cm，第三脑室宽度<0.3cm。侧脑室额角宽度和蛛网膜下腔 CSF 空间的演变似乎没有起到作用。
MMC 产前 MRI 评估相关的产前脑室扩大提供了具有预测价值的参数，预示着出生后 CSF 分流术的可能性。同样，对宫内 MRI 研究的分析可以识别那些出生后发生进行性脑积水风险较低的患者，从而鼓励在当前临床实践中更谨慎地对待早期植入 CSF 分流装置。
