Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.
Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain.
Early Hum Dev. 2024 Oct;197:106109. doi: 10.1016/j.earlhumdev.2024.106109. Epub 2024 Aug 26.
Congenital defects of the central nervous system are the second cause of disability in childhood, representing up to 20 % of structural malformations diagnosed prenatally. The accurate prenatal diagnosis of fetal neurological anomalies and the assessment of cortical development are critical for early intervention and improved long-term outcomes. Neurosonography plays a vital role in this process, providing detailed insights into the structural and functional development of the fetal brain. This systematic review aims to synthesize current knowledge on neurosonographic indicators for prenatal diagnosis, with a special focus on cortical development and its impact in cases of fetal growth defects.
We conducted a comprehensive search for primary literature in PubMed database were searched for English and Spanish-language, peer-reviewed literature published in the last 15 years. Additional articles were identified by scrutinizing others search platforms (Cochrane Library, UpToDate). Inclusion criteria were single pregnancy and no known feto-maternal pathologies at the beginning of the study.
Of the 361 published abstracts identified, 35 met criteria for inclusion. The review highlighted the importance of detailed neurosonographic assessments, including the evaluation of cerebral fissures such as the Sylvian fissure, parieto-occipital fissure, and calcarine fissure. Targeted ultrasound techniques were found to provide comprehensive insights comparable to fetal magnetic resonance imaging. We underscored the significant impact of intrauterine growth restriction on cortical development, with early intervention being crucial. Genetic and congenital infection screenings were emphasized as essential components of prenatal assessment.
The assessment of fetal brain maturation patterns according to gestational age allows us to rule out a delay in cortical development. The heterogeneity of methods and evaluable parameters in fetal neurodevelopment makes it necessary to standardize the evaluation of the main structures of interest both for screening and for the diagnosis of cortical development anomalies, even with the aim of trying to improve upgrade prognostic advice.
中枢神经系统先天缺陷是儿童残疾的第二大原因，占产前诊断出的结构性畸形的 20%。准确的产前诊断胎儿神经异常和皮质发育评估对早期干预和改善长期预后至关重要。神经超声在这个过程中起着至关重要的作用，为胎儿大脑的结构和功能发育提供了详细的见解。本系统综述旨在综合目前关于神经超声产前诊断指标的知识，特别关注皮质发育及其在胎儿生长缺陷中的影响。
我们在 PubMed 数据库中进行了全面的文献检索，检索了过去 15 年发表的英文和西班牙文同行评议文献。通过仔细审查其他搜索平台（Cochrane Library、UpToDate），确定了其他文章。纳入标准为单胎妊娠且在研究开始时无已知的胎儿-母体病理。
在 361 篇已发表的摘要中，有 35 篇符合纳入标准。综述强调了详细的神经超声评估的重要性，包括对大脑裂的评估，如大脑外侧裂、顶枕裂和距状裂。靶向超声技术被发现可以提供与胎儿磁共振成像相当的全面见解。我们强调了宫内生长受限对皮质发育的重大影响，早期干预至关重要。强调了遗传和先天性感染筛查作为产前评估的重要组成部分。
根据胎龄评估胎儿大脑成熟模式可以排除皮质发育延迟。胎儿神经发育中方法和可评估参数的异质性使得有必要规范感兴趣的主要结构的评估，无论是为了筛查，还是为了诊断皮质发育异常，甚至是为了尝试改善预后建议。
