Progression Of Ventriculomegaly Research Articles

A prospective study of prenatal ventriculomegaly: natural course, survival, and neurodevelopmental status.

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.

Sonographic spectrum and postnatal outcomes of early-onset versus late-onset fetal cerebral ventriculomegaly

Objectives To review the prenatal characteristics and postnatal outcomes of Early-onset and Late-onset cerebral ventriculomegaly (VM). Methods Single-center retrospective study 2013–2017; VM cases grouped into Early-onset VM (EVM; Diagnosis at/before 24 weeks) and Late-onset VM (LVM; Beyond 24 weeks). LVM cases had normal ventricle width measurement at mid-trimester scan. Infection serology, cytogenetics, MRI, sonographic follow-up, perinatal and neurodevelopmental outcomes were analyzed. Results During the 5-year period, 64,662 women underwent an anomaly screening scan and 302 fetuses were identified with ventriculomegaly; 183 (60.6%) classified as early-onset and 119 (39.4%) LVM. The mean ventricular width was significantly higher in LVM cohort (14.1 mm vs 11.6 mm; p < .01). EVM cases were more often associated with structural anomalies (p < .05). Possible etiologies for EVM were aneuploidy and cerebral malformations like Absent Corpus Callosum, spina bifida, Dandy–Walker malformation, etc., whereas LVM followed aqueductal stenosis, hemorrhage, porencephaly, cerebral tumors, etc. Pregnancy outcomes were available for 251 cases. The pregnancy resulted in more live births in LVM group (87.4% vs 65.6%, p = < .01). Multivariate regression analysis demonstrated additional malformations (p < .0001, OR11.5 [95%CI: 4–35.2]), progression of VM (p = .004, OR 10.2 [95% CI: 2.1–52.3]) and severity of VM (OR 5.3 [95%CI: 0.8–37.7]) were significant predictors of Neurodevelopmental Impairment (NDI). Late gestation at diagnosis was more often associated with NDI (p = .063, OR2.4 [95%CI: 0.9–6.2]), although statistically insignificant. Conclusions EVM has a significantly different sonographic spectrum and outcomes compared to LVM. EVM is milder and associated with an increased risk of aneuploidy and structural malformations. LVM often occurs secondary to acquired brain lesions.

P24.08: Prenatal sonographic diagnosis of congenital arachnoid cyst: clinical outcomes in a tertiary care centre

To investigate the prenatal ultrasonographic(US) findings which are associated to abnormality and neonatal outcome of 21 fetuses with congenital arachnoid cysts(CAC) diagnosed antenatally. A retrospective study of all cases which were prenatally and postnatally diagnosed as CACs was performed in patients referred to the Severance Hospital from November 2005 to December 2016. 17 CAC fetuses were identified by US at the median gestational age of 30 weeks (range 24-38). Of the 17 probable CAC, 11 (64.7%) cases were diagnosed with CAC and 6 cases were confirmed with other diagnosis based on MRI finding. 4 cases were misdiagnosed as other different disease based on prenatal US. 3 (75%) of the 4 misdiagnosed cases were confirmed postnatally as posterior fossa CAC and 1 case was confirmed as intraventricular arachnoid cyst. In terms of location, 7 (46.7%) had CAC in posterior fossa. Of the 15 confirmed CAC, only one case presented agenesis of the corpus callosum and two cases presented secundum atrial septal defect and ventricular septal defect. None of the 15 cases was confirmed as chromosomal abnormality. For 6 cases, conservative management was done, while other 9 babies, fenestration of CAC was performed. In 4 of the 9 cases, surgery was performed in the second week of life (day 6 to 12). Because of enlarged CAC with aggravated symptoms, 4 needed subsequent cystoperitoneal shunt. Depending on the location of CAC, it can be diagnosed incorrectly as other disease with similar US finding. According to our study and previous literature, the prognosis of CAC depends on the presence of the corpus callosum or other congenital malformations, and the progression of ventriculomegaly. Therefore, if CAC is suspected, it is necessary to conduct the detailed US screening for congenital malformation. Also, there is a need for proper consultation for parents with regard to the possibility of surgery after delivery.

FETAL CEREBRAL “BORDERLINE” VENTRICULOMEGALY

Ventriculomegaly represents the dilation of the cerebral ventricles above 10 mm, being classified as it follows: mild or “borderline” (10-12 mm), moderate (13-15 mm) and severe (over 15 mm). The incidence varies very much depending on the used technique and the gestational age. The level of choice in order to obtain the most exact measurement of the ventricular diameter is at the level of choroid plexus glomus. The MRI is another method to assess the fetal brain that allows also the evaluation of the cerebral surface. Unilateral ventriculomegaly is caused by the morphologic, physical or functional obstruction of foramen Monro. “Borderline” ventriculomegaly can be associated with chromosomal anomalies, congenital infections, cerebral vascular accidents or hemorrhage, but also other extra-cerebral anomalies. The factors that influence the prognosis of children diagnosed with mild ventriculomegaly are: gender, gestational age, ventricular size, uni- or bilateral impairment, symmetrical or asymmentrical bilateral ventriculomegaly, progression of ventriculomegaly – probably the most important factor of prognosis, regression of ventriculomegaly. The parents must be informed about the fact that there are certain ultrasonographic limitations regarding the differentiation of an isolated “borderline” ventriculomegaly of a ventriculomegaly associated to other occult anomalies that can not be identified initially, in order to take an adequate decision. The control fetal ultrasound is preferable to be performed after approximately 1-2 weeks from the moment of initial diagnosis of “ventriculomegaly”.

Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly.

Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10-15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

3D Modeling of the Lateral Ventricles and Histological Characterization of Periventricular Tissue in Humans and Mouse.

The ventricular system carries and circulates cerebral spinal fluid (CSF) and facilitates clearance of solutes and toxins from the brain. The functional units of the ventricles are ciliated epithelial cells termed ependymal cells, which line the ventricles and through ciliary action are capable of generating laminar flow of CSF at the ventricle surface. This monolayer of ependymal cells also provides barrier and filtration functions that promote exchange between brain interstitial fluids (ISF) and circulating CSF. Biochemical changes in the brain are thereby reflected in the composition of the CSF and destruction of the ependyma can disrupt the delicate balance of CSF and ISF exchange. In humans there is a strong correlation between lateral ventricle expansion and aging. Age-associated ventriculomegaly can occur even in the absence of dementia or obstruction of CSF flow. The exact cause and progression of ventriculomegaly is often unknown; however, enlarged ventricles can show regional and, often, extensive loss of ependymal cell coverage with ventricle surface astrogliosis and associated periventricular edema replacing the functional ependymal cell monolayer. Using MRI scans together with postmortem human brain tissue, we describe how to prepare, image and compile 3D renderings of lateral ventricle volumes, calculate lateral ventricle volumes, and characterize periventricular tissue through immunohistochemical analysis of en face lateral ventricle wall tissue preparations. Corresponding analyses of mouse brain tissue are also presented supporting the use of mouse models as a means to evaluate changes to the lateral ventricles and periventricular tissue found in human aging and disease. Together, these protocols allow investigations into the cause and effect of ventriculomegaly and highlight techniques to study ventricular system health and its important barrier and filtration functions within the brain.

O.065 Pathology of AD-related inflammatory and oxidative stress mediators in Kaolin-induced hydrocephalus model of the aged rat

The present study describes the biochemical changes, morphological development and the cerebrospinal fluid dynamics of the kaolin-induced hydrocephalus in the adult rat. Two, 4 and 6 weeks after microsurgical kaolin instillation into the rat cisterna magna the basal intracranial pressure and the cerebrospinal fluid outflow resistance were measured. To determine possible biochemical changes in the rat cerebrum, brain stem and cerebellum the concentrations of glutamine, glutamate, glutathione, aspartate, GABA, alanine and taurine were measured by high pressure liquid chromatography. In addition, ventriculomegaly and syringomyelia were assessed, measuring the lateral ventricles and central canals by means of an image-processing computer program. It could be shown that the acute phase of kaolin-induced hydrocephalus in the first 4 weeks is characterised by a high basal intracranial pressure, a considerably increased CSF outflow resistance and a rise in brain water content in the fourth week. The changes in the concentrations of amino acids were moderate. Glutamine was increased and taurine was decreased in the cerebrum and alanine was increased in the brain stem. The chronic phase, however, is defined by normal basal pressure, declining outflow resistance, progression of ventriculomegaly and distinct changes in the biochemical parameters such as a remarkable decrease of glutamate, glutamine and taurine in the cerebellum, a decrease of taurine and alanine plus an increase in glutamine in the cerebrum and an increase of alanine in the brain stem. Moreover, cerebral metabolism in the adult rat seems to be more resistant to the effects of hydrocephalus than metabolism in neonatal and infantile rats.

Impact of maternal fetal surgery for myelomeningocele on the progression of ventriculomegaly in utero

Impact of maternal fetal surgery for myelomeningocele on the progression of ventriculomegaly in utero

Alterations in brain metabolism, CNS morphology and CSF dynamics in adult rats with kaolin-induced hydrocephalus

The present study describes the biochemical changes, morphological development and the cerebrospinal fluid dynamics of the kaolin-induced hydrocephalus in the adult rat. Two, 4 and 6 weeks after microsurgical kaolin instillation into the rat cisterna magna the basal intracranial pressure and the cerebrospinal fluid outflow resistance were measured. To determine possible biochemical changes in the rat cerebrum, brain stem and cerebellum the concentrations of glutamine, glutamate, glutathione, aspartate, GABA, alanine and taurine were measured by high pressure liquid chromatography. In addition, ventriculomegaly and syringomyelia were assessed, measuring the lateral ventricles and central canals by means of an image-processing computer program. It could be shown that the acute phase of kaolin-induced hydrocephalus in the first 4 weeks is characterised by a high basal intracranial pressure, a considerably increased CSF outflow resistance and a rise in brain water content in the fourth week. The changes in the concentrations of amino acids were moderate. Glutamine was increased and taurine was decreased in the cerebrum and alanine was increased in the brain stem. The chronic phase, however, is defined by normal basal pressure, declining outflow resistance, progression of ventriculomegaly and distinct changes in the biochemical parameters such as a remarkable decrease of glutamate, glutamine and taurine in the cerebellum, a decrease of taurine and alanine plus an increase in glutamine in the cerebrum and an increase of alanine in the brain stem. Moreover, cerebral metabolism in the adult rat seems to be more resistant to the effects of hydrocephalus than metabolism in neonatal and infantile rats.

Ventriculomegaly Diagnosed by Prenatal Ultrasound and Mental Development of the Children

During the last 8 years in our department, fetal ventriculomegaly was diagnosed by prenatal ultrasound in 105 cases. Ventriculomegaly was detected at 25 ± 6 weeks of gestation. In 96 of 105 cases follow-up examinations have been performed both during pregnancy and after delivery. In 47 cases termination of pregnancy, late spontaneous abortion or intrauterine death occurred. 49 cases resulted in live births. Of these, 28 children could be followed up to the age of 36 months, a few children even longer. Myelomeningocele was the most frequent cause of ventriculomegaly (17 cases = 61%). Insertion of ventricular shunt systems was performed in 26 children at a median of 21 days of life. Analysis of postnatal development was performed by the Kaufmann Assessment Battery for Children, or the Munich Functional Development Test. Correlation analysis was performed between parameters of prenatal findings and postnatal development. It could be shown that results of single prenatal ultrasound examinations did not correlate with postnatal development whereas progression of ventriculomegaly was negatively correlated with mental development.