Surgical interventions for fetal hydrocephalus: systematic review
C Murray1, K Nicolaides2, C Bleil3
1Department of Paediatric Neurology, King's College Hospital NHS Foundation Trust, London, UK.
Summary
Surgical interventions for fetal hydrocephalus show mixed developmental outcomes, with isolated cases faring better. Poor data quality and short-term assessments limit current understanding, necessitating further research with randomized controlled trials.
Area of Science:
- Medical Science
- Fetal Surgery
- Neonatal Development
Background:
- Fetal hydrocephalus presents complex management challenges.
- Surgical interventions aim to improve outcomes but require careful evaluation.
Purpose of the Study:
- To assess the effectiveness and developmental outcomes of surgical treatments for fetal hydrocephalus.
- To review existing literature on surgical interventions for fetal hydrocephalus.
Main Methods:
- Comprehensive literature search across major databases (MEDLINE, CINAHL, EMBASE, CENTRAL) up to April 2024.
- Inclusion of case reports, case series, cohort studies, and RCTs on surgical interventions for fetal hydrocephalus.
- Exclusion of studies without reported developmental outcomes or those solely for delivery facilitation or spina bifida.
Main Results:
- 12 studies analyzed 172 participants undergoing cephalocentesis, ventriculoamniotic shunts, or endoscopic third ventriculostomy.
- Ventriculoamniotic shunts had a 6.9% complication rate, with 32.1% shunt failure.
- Developmental outcomes varied: 46% normal, 8.8% mild, and 45.3% moderate/severe difficulties; isolated hydrocephalus showed better outcomes (55.8% normal).
Conclusions:
- Surgical intervention effectiveness is hampered by case identification issues and preterm birth complications.
- Isolated fetal hydrocephalus cases demonstrate better developmental trajectories.
- Future research should incorporate advanced imaging, genetic studies, and randomized controlled trials for robust conclusions.
