Percutaneous fetal endoscopic third ventriculostomy for severe isolated cerebral ventriculomegaly

• Published in: Prenatal diagnosis 2023-12, Vol.43 (13), p.1614-1621
• Main Authors: Peralta, Cleisson Fábio Andrioli, Medrado, Aletea Patrícia, Botelho, Rafael Davi, Jorge Rodrigues da Costa, Karina, Imada, Vanessa, Lamis, Fabricio
• Format: Article
• Language: English
• Subjects: Atria; Complications; Endoscopy; Feasibility; Female; Fetus - surgery; Fetuses; Gestational age; Humans; Hydrocephalus - complications; Hydrocephalus - diagnostic imaging; Hydrocephalus - surgery; Infant; Infant, Newborn; Infants; Neonates; Pregnancy; Retrospective Studies; Third Ventricle - diagnostic imaging; Third Ventricle - surgery; Treatment Outcome; Ventricle; Ventricles (cerebral); Ventriculoperitoneal shunt; Ventriculostomy - adverse effects; Ventriculostomy - methods
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.6465

Objective To demonstrate the feasibility and preliminary results of percutaneous fetal endoscopic third ventriculostomy (ETV) in human fetuses (pfETV) with isolated progressive and/or severe bilateral cerebral ventriculomegaly (IPSBV). Methods The initial results of pfETV for IPSBV were described. Perioperative, perinatal and postnatal variables were described. The Ages and Stages Questionnaire (ASQ‐3), 3rd edition (ASQ‐3) was used for follow‐up of all infants. Results Successful pfETV was performed in 10/11 (91%) fetuses, at a median gestational age (GA) of 28.7 weeks (25.3–30.7). There were no perioperative complications. After pfETV, 70% (7/10) of the fetuses had a decreased or stabilized lateral ventricle atria|lateral ventricle's atria. The median GA at delivery was 38.2 weeks (35.9–39.3). There were no perinatal complications. The postnatal ventriculoperitoneal shunt rate was 80% (8/10). Among neonates/infants who had prenatal stabilization or a decrease in the LVAs, 4 (4/7: 57.1%) had abnormal scores on the ASQ‐3. Among neonates/infants that experienced prenatal increases in the LVAs, all of them (3/3: 100%) had abnormal scores on the ASQ‐3. Conclusion Percutaneous ETV is feasible in human fetuses with progressive and/or severe cerebral ventriculomegaly and seems to be a safe procedure for both the mother and the fetus. Key points What is known about this topic? Data about the possible benefits of ventriculoamniotic shunting for fetal cerebral ventriculomegaly are conflicting. Compared with ventriculoperitoneal shunts, postnatal third ventriculostomy is associated with a shorter surgery time, lower postoperative complication and reoperation rates, and longer survival. Experimental studies demonstrated the feasibility and possible efficacy of endoscopic third ventriculostomy (ETV) to treat cerebral ventriculomegaly in fetal sheep models. What does this article add? Percutaneous ETV is feasible in human fetuses with progressive and/or severe cerebral ventriculomegaly and seems to be a safe procedure for both the mother and the fetus.