Surgical management of fetal hydrocephalus

Abstract

Hydrocephalus is an abnormal accumulation of cerbrospinal fluid (CSF) resulting to enlargement of the ventricular system where intracranial pressure is frequently elevated. Neonatal hydrocephalus is one of the most common central nervous system (CNS) congenital anomalies in the world. The big difference between a hydrocephalic fetus and a hydrocephalic neonate is that, in the former case, it is the mother-fetus binomial-that is involved. No matter what procedure should be performed, it is the mother that should be taken into consideration. From the simple natural childbirth to the most complex prenatal neurosurgical procedures, whenever hydrocephaly is to be treated during the fetal period, the mother will have to face some risks involving ethical, religious, and socioeconomical problems that normally do not exist for the newborn infant. Another essential factor concerns prematurity. The decision to induce labor and treat the hydrocephalus cannot be complicated with prematurity problems. It is up to the neurosurgeon to choose the best moment for delivery, considering both the hydrocephalus degree and the risks of prematurity. The best overall results in fetal surgery have been those obtained in cases of acute obstructive hydrocephalus having developed no earlier than the third trimester of gestation and were not associated with any other malformation (Kirkinen et al., Ann Med 28:131-6, 1996). Knowledge about both diagnosis and treatment of this serious type of hydrocephalus can be still improved in health centers specialized in fetal medicine.