Two-step procedure for early neonatal surgery of fetal hydrocephalus

This retrospective study analyzed the diagnosis and treatment of 36 infants with central nervous system anomalies diagnosed antenatally by ultrasonographic studies between December, 1987 and December, 1990. Magnetic resonance imaging of the fetuses without maternal or fetal sedation/anesthesia was very useful, as the fetal ventricular system was depicted clearly. Twenty-three infants with hydrocephalus underwent early postnatal surgical emplacement of a miniature Ommaya's reservoir. Continuous cerebrospinal fluid aspiration was combined with intracranial pressure monitoring. Observation of the ventricular size used ultrasonography through the anterior fontanelle. This technique controlled the intracranial pressure during the early neonatal period without serious complications. A ventriculoperitoneal shunt was emplaced 1 month later as the second, more permanent treatment. This two-step procedure achieves brain reconstitution and prevents irreversible neurological damages. Clinical and radiographic findings are presented to illustrate the effectiveness of this approach.