1Department of Neurology, Mofid Hospital, Shahid Beheshti University of Medical Science, Tehran; and.
2Department of Neurosurgery, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.
J Neurosurg Pediatr. 2023 Mar 24;32(1):44-49. doi: 10.3171/2023.2.PEDS22522. Print 2023 Jul 1.
Prenatal ventriculomegaly (VM) is classified as mild, moderate, or severe on the basis of the diameter of the atrium. Neurodevelopmental status in prenatal VM is associated with various factors such as the course of VM, VM type, progression, and associated anomalies. In this study, the authors aimed to evaluate neurodevelopmental outcome in patients with prenatal VM and to detect possible associated risk factors.
In this study, 73 pregnancies with VM who were referred to Children's Medical Center, Tehran, Iran, between 2019 and 2021 were prospectively followed. They were followed up every 2-4 weeks with ultrasonography (US) before delivery and were then observed for an average time of 14.6 months. The authors collected demographic and ultrasound information, associated abnormalities, pregnancy outcomes, and developmental status according to Centers for Disease Control criteria.
The mean gestational age at the time of diagnosis was 28.1 weeks, and 46.6% of fetuses were female. According to the first US, 46.6% had mild, 21.9% had moderate, and 31.5% had severe VM. Serial US scans showed that VM had regressed in 20.5% of patients, remained stable in 35.6%, and progressed in 43.8%. Other cranial abnormalities were detected in 38.4% of fetuses. During follow-up, 62.5% of cases had normal developmental status, 26.6% had mild delay, and 10.9% had severe neurodevelopmental delay. Pregnancy was terminated in 9 (12.3%) cases. Normal neurodevelopment was reported in 75.8% of patients with mild VM versus 50% of those with severe VM (p = 0.19). Neurodevelopmental status was normal in 72.5% of cases without other cranial abnormalities (p = 0.018) and in 86.7% of cases with regression of VM (p = 0.028).
Despite analysis of different factors in prenatal VM, only progression of VM and associated cranial abnormalities had significant relationships with neurodevelopmental prognosis.
根据心房直径，产前脑室扩大（VM）分为轻度、中度或重度。产前 VM 的神经发育状况与 VM 病程、VM 类型、进展和相关异常等多种因素有关。本研究旨在评估产前 VM 患者的神经发育结局，并检测可能的相关危险因素。
本研究前瞻性随访了 2019 年至 2021 年期间伊朗德黑兰儿童医学中心转诊的 73 例 VM 妊娠患者。他们在分娩前每 2-4 周进行一次超声（US）检查，然后平均随访 14.6 个月。研究者收集了人口统计学和超声信息、相关异常、妊娠结局和根据疾病控制中心标准的发育状况。
诊断时的平均孕龄为 28.1 周，46.6%的胎儿为女性。根据首次 US 结果，46.6%为轻度 VM，21.9%为中度 VM，31.5%为重度 VM。连续 US 扫描显示，20.5%的患者 VM 消退，35.6%的患者 VM 稳定，43.8%的患者 VM 进展。38.4%的胎儿还存在其他颅面异常。在随访期间，62.5%的病例发育正常，26.6%的病例有轻度发育迟缓，10.9%的病例有严重的神经发育迟缓。9 例（12.3%）终止妊娠。轻度 VM 患者中，75.8%的神经发育正常，重度 VM 患者中，50%的神经发育正常（p=0.19）。无其他颅面异常的病例中，72.5%的神经发育正常（p=0.018），VM 消退的病例中，86.7%的神经发育正常（p=0.028）。
尽管对产前 VM 中的不同因素进行了分析，但只有 VM 的进展和相关颅面异常与神经发育预后有显著关系。
