Cerebrospinal fluid, also known as cerebro spinal fluid, is a
fluid that is constantly created in the brain and takes part in the protection
of the brain, transporting its needs and waste. CSF is produced mostly in the
brain in the region called choroid plexus. Cerebrospinal fluid circulates in
ventricles and pathways located in the brain, as well as on the outer surface
of the spinal cord and brain. Ventriculomegaly is a term used to mean
enlargement of these ventricles.
The measurement of the lateral ventricles in the brain (at
the level of the atrium) should normally be below 10 mm. 10 mm or more is
called ventriculomegaly. If it is between 10-15 mm, it is called mild
ventriculomegaly. This expansion is caused by a blockage or developmental
disorder somewhere. With this expansion with increased pressure, this is called
hydrocephalus. These two terms are often used in the same sense, since it
cannot be understood whether there is this pressure increase in tests before
birth. Mild ventriculomegaly occurs in 2-20 per 1000 pregnancies, while
hydrocephalus occurs in 1-3 per 1000 pregnancies.
Ventriculomegaly or hydrocephalus can usually be recognized
by ultrasound performed during pregnancy. MR (magnetic resonance) can help
diagnosis. The reason is usually due to congenital stenosis in the aquduct.
This stenosis may sometimes be due to infections such as CMV or toxoplasma, or
a mass in the head or intracranial bleeding.
In cases where ventriculomegaly is larger than 15 mm,
although it is generally isolated on ultrasound initially, that is, no other
anomalies are seen, later, some other anomalies accompany it. (Neural tube
defect, Arnold-Chiari malformation, corpus callosum agenesis, arachnoid cyst,
Dandy-Walker syndrome ...)
Follow-up
of pregnancy:
When ventriculomegaly or hydrocephalus is diagnosed,
chromosomal examination of the fetus with amniocentesis, detailed anomaly
screening with echocardiography and ultrasound must be performed. Whether there
are other anomalies accompanying ventriculomegaly should be investigated in
ultrasonography. Amniocentesis is recommended to be performed even in mild
ventriculomegalies and it is investigated whether there is concomitant
chromosomal genetic abnormality. Whether accompanying neural tube defect in amniocentesis
(AFP, with acetylcholinesterase) can be investigated, as well as infection
factors.
It should be questioned whether an infection that may cause
hydrocephalus was experienced during pregnancy. Such as Toxoplasma, CMV,
chicken pox, rubella, HSV ...
A decrease or increase in ventriculomegaly should be followed
with intermittent ultrasound controls. Mild ventriculomegalies usually improve
in the last months of pregnancy. Sometimes MRI can be used to examine the brain
structure of the fetus in more detail.
In pregnancies with ventriculomegaly, the family should
decide to terminate or continue pregnancy. If the pregnancy is not terminated
and continues, the family is informed about postpartum care and treatment. If
the head diameter is not larger than normal and there is no other reason,
delivery can take place normally. If the head diameter is large, cesarean is
required.
What is the
health status of babies after birth?
If the ventriculomegaly detected during pregnancy is mild and
no accompanying anomaly has been observed, the state of health (60-80%) will
generally be completely normal after birth. If the ventriculomegaly width is
high, the risk of developing postpartum problems will also increase. If
ventriculomegaly gradually grows during pregnancy and other concomitant
anomalies are detected, the risk of postpartum health problems increases.
Various problems related to the nervous system (such as vision problems,
walking problems) may develop, and the head diameter and fontanel (fontanel)
can be large.
Ventriculomegaly should be distinguished from what is called
megalocephalus or macrocephaly (large head). The macrocephaly head
circumference is 2 standtard deviations larger than normal. Megalocephalus is
an increase in brain tissue. Ventriculomegaly may or may not accompany
macrocephaly or megalocephalus. In case of macrocephaly (large head), cesarean
delivery is recommended. The baby is evaluated in terms of the size of the head
and the width of the ventricles after birth, and if there are no other accompanying
abnormalities, the baby continues to live without neurological, developmental,
mental problems.
Dandy-Walker
malformation: Hydrocephalus is an anomaly characterized by retroserebellar
cyst and abnormal cerebellar vermis. This malformation is often accompanied by
other brain or heart-related malformations.
-CHOROID PLEXUS CYST
-CORPUS CALLOSUM AGENESIS (CCA)
-MEGA SISTERNA MAGNA
-MEGALENCEPHALY
-MICROCEPHALY
