Fetal hydrocephalus

Hydrocephalus is the most frequent and devastating illness affecting a fetus. The development of both ultrasonography and magnetic resonance, associated with laboratorial tests, has greatly facilitated its diagnosis.

In the Fetal Medicine Service of the Federal University of São Paulo and in the Santa Joana/Pro-Matre Paulista Hospital Complex, in São Paulo, SP, Brazil, repeated cephalocenteses, ventricular-amniotic shunting, and neuroendoscopy were used to treat 57 fetuses with hydrocephalus, all of them at a gestational age under 32 weeks. Another eight fetuses had myelomeningocele and underwent correctional open surgery to prevent hydrocephalus.

Thirty-nine patients were followed up for a period longer than 3 years and had their intelligence coefficient assessed: 26 of them were considered normal (IQ above 70); six had mild or moderate handicaps (IQ from 35 to 70), and seven were severely handicapped (IQ below 35). Out of the eight patients operated for correction of myelomeningocele, only two came to require shunting. There were no cases of maternal morbidity, and no infectious condition was observed in any of the patients subjected to intrauterine treatment.

Selected cases of isolated, evolutive, non-destructive hydrocephaly diagnosed before 32 gestational weeks may benefit from fetal neurosurgical procedures. With the accuracy improvement of diagnoses, the number of patients fitting into that group has become very small.