Fetal Intraventricular Hemorrhage in Open Neural Tube Defects: Prenatal Imaging Evaluation and Perinatal Outcomes

Area of Science:

• Medical Imaging
• Pediatric Neurology
• Fetal Medicine

Background:

• Fetal imaging is vital for evaluating open neural tube defects (ONTDs).
• The clinical significance of prenatal intraventricular hemorrhage (IVH) in ONTDs remains unclear.
• This study investigates fetal imaging findings and their associations in ONTDs.

Purpose of the Study:

• To explore fetal imaging findings in open neural tube defects.
• To evaluate associations between prenatal intraventricular hemorrhage and hindbrain herniation (prenatal and postnatal).
• To assess the relationship between prenatal intraventricular hemorrhage and postnatal intraventricular hemorrhage, and ventricular shunt placement.

Main Methods:

• Retrospective enrollment of 504 cases with open neural tube defects evaluated by prenatal sonography (2013-2018).
• Classification based on the presence of intraventricular hemorrhage and gray matter heterotopia via prenatal sonography and MR imaging.
• Comparison of outcomes using regression analyses between cases with intraventricular hemorrhage and controls.

Main Results:

• Prenatal intraventricular hemorrhage was linked to increased rates of prenatal and postnatal hindbrain herniation and postnatal intraventricular hemorrhage compared to controls.
• Increased third ventricular diameter (>1 mm) predicted hindbrain herniation independently.
• Fetal closure was protective against postnatal hindbrain herniation and postnatal intraventricular hemorrhage.

Conclusions:

• Intraventricular hemorrhage is a frequent finding in prenatal ONTD evaluations.
• Hindbrain herniation is more common with prenatal intraventricular hemorrhage, particularly with increased third ventricular size.
• Fetal closure mitigates hindbrain herniation and reduces postnatal intraventricular hemorrhage, irrespective of prenatal intraventricular hemorrhage presence.