Mild fetal ventriculomegaly: diagnosis, evaluation, and management
Mild fetal ventriculomegaly: diagnosis, evaluation, and management
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DOI：
10.1016/j.ajog.2018.04.039
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发表时间：
2018-07-01
影响因子：
9.8
通讯作者：
Norton, Mary E.
中科院分区：
文献类型：
--
作者：
Fox, Nathan S.;Monteagudo, Ana;Norton, Mary E.
医学实践不断发展，个人情况也会有所不同。本意见反映了接受发表时可获得的信息，并非旨在或旨在建立医疗实践的排他性标准。本出版物预计不会反映母胎医学学会所有成员的意见。脑室扩大被定义为胎儿脑室扩张，是产前超声检查中相对常见的发现。本文件的目的是回顾轻度胎儿脑室扩大的诊断、评估和治疗。当发现侧脑室增大（>= 10 mm）时，应进行彻底的评估，包括对胎儿解剖结构进行详细的超声检查评估、羊膜穿刺术进行核型和染色体微阵列分析，以及胎儿感染的检查。在某些情况下，胎儿磁共振成像可能会识别其他中枢神经系统异常，当这项技术以及专家解释可用时，应予以考虑。应进行后续超声检查以评估心室扩张的进展情况。在孤立性脑室扩大 10-12 毫米的情况下，神经发育正常且存活的可能性 >90%。对于中度脑室扩张（13-15 毫米），神经发育正常的可能性为 75-93%。以下是母胎医学协会的建议： 我们建议出于患者咨询的目的，将脑室扩大分为轻度 (10-12 mm)、中度 (13-15 mm) 或重度 (>15 mm)，因为当心室测量值 13-15 mm 与 10-12 mm 相比，出现不良结果和其他异常的可能性更高 (GRADE 2B)；我们建议，当检测到脑室扩大时，应进行染色体微阵列分析的诊断测试（羊膜穿刺术）（GRADE 1B）；我们建议在检测到脑室扩大时进行巨细胞病毒和弓形体病检测，无论已知的暴露情况或症状如何（GRADE 1B）；我们建议在有轻度或中度胎儿脑室扩大的情况下考虑磁共振成像，当这种方式和专家放射学解释可用时；如果患者由在胎儿大脑超声成像方面具有特定经验和专业知识的个人进行了详细的超声检查，则磁共振成像的价值可能会降低（GRADE 2B）；我们建议分娩时间和方式基于标准产科指征（GRADE 1C）；我们建议，对于 10-12 毫米的孤立性轻度脑室扩大，在进行完整评估后，建议女性结果良好，婴儿可能是正常的（1B 级）；我们建议，对于 13-15 毫米的孤立性中度脑室扩大，在进行完整评估后，建议女性结果可能是有利的，但神经发育障碍的风险增加（1B 级）。
The practice of medicine continues to evolve and individual circumstances will vary. This opinion reflects information available at the time of acceptance for publication and is neither designed nor intended to establish an exclusive standard of medical practice. This publication is not expected to reflect the opinions of all members of the Society for Maternal-Fetal Medicine.Ventriculomegaly is defined as dilation of the fetal cerebral ventricles and is a relatively common finding on prenatal ultrasound. The purpose of this document is to review the diagnosis, evaluation, and management of mild fetal ventriculomegaly. When enlargement of the lateral ventricles (>= 10 mm) is identified, a thorough evaluation should be performed, including detailed sonographic evaluation of fetal anatomy, amniocentesis for karyotype and chromosomal microarray analysis, and a workup for fetal infection. In some cases, fetal magnetic resonance imaging may identify other central nervous system abnormalities and should be considered when this technology as well as expert interpretation is available. Follow-up ultrasound examination should be performed to assess for progression of the ventricular dilation. In the setting of isolated ventriculomegaly of 10-12 mm, the likelihood of survival with normal neurodevelopment is >90%. With moderate ventriculomegaly (13-15 mm), the likelihood of normal neurodevelopment is 75-93%. The following are Society for Maternal-Fetal Medicine recommendations: We suggest that ventriculomegaly be characterized as mild (10-12 mm), moderate (13-15 mm), or severe (>15 mm) for the purposes of patient counseling, given that the chance of an adverse outcome and potential for other abnormalities are higher when the ventricles measure 13-15 mm vs 10-12 mm (GRADE 2B); we recommend that diagnostic testing (amniocentesis) with chromosomal microarray analysis should be offered when ventriculomegaly is detected (GRADE 1B); we recommend testing for cytomegalovirus and toxoplasmosis when ventriculomegaly is detected, regardless of known exposure or symptoms (GRADE 1B); we suggest that magnetic resonance imaging be considered in cases of mild or moderate fetal ventriculomegaly when this modality and expert radiologic interpretation are available; magnetic resonance imaging is likely to be of less value if the patient has had a detailed ultrasound performed by an individual with specific experience and expertise in sonographic imaging of the fetal brain (GRADE 2B); we recommend that timing and mode of delivery be based on standard obstetric indications (GRADE 1C); we recommend that with isolated mild ventriculomegaly of 10-12 mm, after a complete evaluation, women be counseled that the outcome is favorable, and the infant is likely to be normal (GRADE 1B); we recommend that with isolated moderate ventriculomegaly of 13-15 mm, after a complete evaluation, women be counseled that the outcome is likely to be favorable but that there is an increased risk of neurodevelopmental disabilities (GRADE 1B).