Antenatally Diagnosed Ventriculomegaly: Postnatal Clinical Course and Neurodevelopmental Insights

Antenatal ventriculomegaly (VM), a prevalent fetal central nervous system (CNS) abnormality, ranges from isolated VM to VM with additional CNS abnormalities. This study aimed to analyze postnatal diagnoses and clinical outcomes of patients with antenatal VM to identify key prenatal factors.

Neonates born at ≥35 weeks of gestation between 2010 and 2022 with antenatal VM were retrospectively reviewed. Patients were categorized as VM with other CNS abnormalities (group A, n=95), isolated VM (group B, n=40), and resolved VM (group C, n=80). CNS abnormalities identified postnatally but not prenatally were classified as group A2 (n=38). Imaging findings, clinical features, and 2-year neurodevelopmental outcomes were compared.

Group A showed higher rates of bilateral VM (78.9% vs. 50.0% vs. 27.5%, p<0.001), severe VM (>15.0 mm) (47.4% vs. 17.5% vs. 0%, p<0.001), and larger initial ventricle size [12.1 (10.0-37.5) vs. 11.4 (10.0-16.0) vs. 11.0 (10.0-14.0) mm, p<0.001] than groups B and C. In group A2, hemorrhage was the most common abnormality (34%). At 2 years of age, group A had higher rates of epilepsy, developmental delay, and cerebral palsy compared to group B. Developmental delay was noted in 40.2% of group A and 17.5% of group B.

Larger initial ventricle size in antenatal VM was associated with poorer neurodevelopmental outcomes. Normal antenatal findings can obscure postnatal CNS abnormalities. Advanced imaging and postnatal evaluation are essential for timely diagnosis and perinatal counseling and management.