Glick P L, Harrison M R, Nakayama D K, Edwards M S, Filly R A, Chinn D H, Callen P W, Wilson S L, Golbus M S
J Pediatr. 1984 Jul;105(1):97-105. doi: 10.1016/s0022-3476(84)80371-6.
We studied 24 human fetuses with cerebral ventriculomegaly by serial obstetric ultrasound to define the natural history of fetal ventricular enlargement and to develop a management strategy. In 10 fetuses, ventriculomegaly was associated with other severe anomalies; nine of these families chose to terminate the pregnancy. In three other severely affected fetuses in whom ventriculomegaly was detected serendipitously late in gestation, routine obstetrical management was performed; none survived. Eleven fetuses had ventriculomegaly without associated severe anomalies. Ventriculomegaly remained stable or of moderate severity throughout gestation in nine, resolved gradually in one, and progressed in one who did not have signs of increased intracranial pressure at birth. All of these fetuses were viable; three patients required shunting in the neonatal period, and two others by 5 months of age. Although obstetric ultrasound usually can detect anomalies associated with fetal ventriculomegaly, three fetuses with isolated ventriculomegaly had midline brain malformations that could not be distinguished in utero from hydrocephalus, even in retrospect. Prenatal diagnosis improves perinatal management by allowing counseling, and selective pregnancy termination, or selection of the timing, mode, and place of delivery to optimize outcome. Most fetuses with ventriculomegaly do not require intervention before birth.
我们通过系列产科超声检查研究了24例患有脑室扩大的人类胎儿，以明确胎儿脑室扩大的自然病程并制定管理策略。在10例胎儿中，脑室扩大与其他严重畸形相关；其中9个家庭选择终止妊娠。在另外3例在妊娠晚期偶然发现脑室扩大的严重受累胎儿中，进行了常规产科处理；无一存活。11例胎儿有脑室扩大但无相关严重畸形。9例胎儿的脑室扩大在整个妊娠期保持稳定或为中度严重程度，1例逐渐消退，1例在出生时无颅内压升高迹象但病情进展。所有这些胎儿均存活；3例患者在新生儿期需要分流，另外2例在5个月龄时需要分流。尽管产科超声通常能够检测出与胎儿脑室扩大相关的畸形，但3例孤立性脑室扩大的胎儿有中线脑畸形，即使回顾性分析，在子宫内也无法与脑积水区分开来。产前诊断通过提供咨询、选择性终止妊娠或选择分娩时间、方式和地点以优化结局，从而改善围产期管理。大多数脑室扩大的胎儿在出生前不需要干预。
