034. Incidence and predictors of CSF diversion for children prenatally diagnosed with ventriculomegaly on fetal MRI

Authors: Nicole Eva Hernandez

Fetal ventriculomegaly is one of the most common diagnoses urging a fetal magnetic resonance image (MRI). More than 40% of cases of mild ventriculomegaly found in the absence of other anomalies resolve in utero. Herein we assess the natural history of fetal ventriculomegaly and identify the incidence and predictors of postnatal CSF diversion.Methods: A retrospective review was conducted for fetal MRIs performed between January 2012 and December 2020. Infants with central nervous system anomalies identified on prenatal MRI, with at least one postnatal neurosurgical follow-up, were included. Univariate and multivariate logistic regression was performed to evaluate predictors of CSF diversion.
A total of 263 fetal MRIs were performed for 190 infants at our institution; of which, 114 maternal-fetal pairs met the inclusion criteria. Ventriculomegaly is the most common finding which led to prenatal neurosurgical consultation (n=65; 57.0%). The majority (63.1%) of the cases were mild, while 26.1% were moderate and 10.8% were severe. Twelve patients (10.5%) required CSF diversion in the form of either endoscopic third ventriculostomy (ETV CPC) or ventriculoperitoneal shunt (VPS) following birth. The greatest predictors for postnatal CSF diversion were the severity of ventriculomegaly on fetal MRI (p=0.002) and the presence of myelomeningocele (p=0.002). Fetal MRI findings of aqueductal stenosis (p=0.001), corpus callosum thinning (p < 0.001), and the absence of septum pellucidum (p < 0.014) were associated with severe ventriculomegaly. Dandy-Walker complex was more likely to be associated with no or mild ventriculomegaly (p=0.007) that warranted no surgical treatment.
The majority of infants presenting with fetal ventriculomegaly are mild and do not require CSF diversion. Atrial diameter > 15mm and myelomeningocele predicted postnatal CSF diversion, while Dandy-Walker complex and intraventricular hemorrhage did not.