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ARTICLE |

Antenatal Treatment of Hydrocephalus by Ventriculoamniotic Shunting FREE

Fredric D. Frigoletto, Jr, MD; Jason C. Birnholz, MD; Michael F. Greene, MD
[+] Author Affiliations

Reprint requests to Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Frigoletto).


JAMA. 1982;248(19):2496-2497. doi:10.1001/jama.1982.03330190060034
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WE HAVE previously shown that serial percutaneous cephalocenteses could be accomplished safely with continuous ultrasound guidance.1 This method provides only transient relief of elevated intracranial pressure because of prompt fluid reaccumulation. It is apparent that a continuous form of decompression will be required for effective antenatal treatment of hydrocephalus. Percutaneous placement of an indwelling ventriculoamniotic shunt is described.

Report of a Case  A 24 1/2-week-old male fetus was referred by his mother's obstetrician when an ultrasound examination obtained to resolve an apparent size-date disparity at 23 weeks of gestation disclosed fetal hydrocephalus. The mother was a 34-year-old, gravida 4 para 3. Had the option of terminating the pregnancy been available, it would have been unacceptable to both parents. After a thorough discussion with emphasis on the experimental nature of the procedure, they requested that maternal transabdominal ventriculoamniotic shunt placement be attempted.Further ultrasound examination confirmed symmetrical ventricular dilatation. Communication

REFERENCES

Birnholz JC, Frigoletto FD:  Antenatal treatment of hydrocephalus . N Engl J Med 1981;;301:1021-1023.
Birnholz JC:  The development of human fetal eye movement patterns . Science 1981;; 213:679-681.
Frigoletto FD, Birnholz J, Rothchild SB, et al:  Intrauterine transfusion with the use of phased array ultrasonography: A new technique . Am J Obstet Gynecol 1978;;131:273-275.
Hill A, Shackelford G, Volpe JJ:  Ventriculitis with neonatal bacterial meningitis: Identification by real-time ultrasound . J Pediatr 1981;; 99:133-136.
Hodgen GD:  Antenatal diagnosis and treatment of fetal skeletal malformations . JAMA 1981;;246:1079-1083.
Michejda M, Hodgen GD:  In utero diagnosis and treatment of non-human primate fetal skeletal anomalies . JAMA 1981;;246:1093-1097.
Barclay WR, McCormick RA, Sidbury JB, et al:  The ethics of in utero surgery . JAMA 1981;; 246:1550-1555.
Liley AW:  Intrauterine transfusion of foetus in hemolytic disease . Br Med J 1963;;2:1107.
Harrison MR, Filly RA, Parer JT, et al:  Management of the fetus with a urinary tract malformation . JAMA 1981;;246:635-639.

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Birnholz JC, Frigoletto FD:  Antenatal treatment of hydrocephalus . N Engl J Med 1981;;301:1021-1023.
Birnholz JC:  The development of human fetal eye movement patterns . Science 1981;; 213:679-681.
Frigoletto FD, Birnholz J, Rothchild SB, et al:  Intrauterine transfusion with the use of phased array ultrasonography: A new technique . Am J Obstet Gynecol 1978;;131:273-275.
Hill A, Shackelford G, Volpe JJ:  Ventriculitis with neonatal bacterial meningitis: Identification by real-time ultrasound . J Pediatr 1981;; 99:133-136.
Hodgen GD:  Antenatal diagnosis and treatment of fetal skeletal malformations . JAMA 1981;;246:1079-1083.
Michejda M, Hodgen GD:  In utero diagnosis and treatment of non-human primate fetal skeletal anomalies . JAMA 1981;;246:1093-1097.
Barclay WR, McCormick RA, Sidbury JB, et al:  The ethics of in utero surgery . JAMA 1981;; 246:1550-1555.
Liley AW:  Intrauterine transfusion of foetus in hemolytic disease . Br Med J 1963;;2:1107.
Harrison MR, Filly RA, Parer JT, et al:  Management of the fetus with a urinary tract malformation . JAMA 1981;;246:635-639.
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