Fetal Surgery for Hydrocephalus

Hydrocephalus is a condition characterized by an abnormal increase in the amount of brain fluid, often causing enlargement of the head and damage to the brain.  After birth, hydrocephalus is usually treated by placement of a shunt, or drain, which allows the fluid to escape.

During the 1980's a number of attempts were made to place a drain before delivery, in the hope of preventing neurological injury.  These attempts were hampered by the lack of a reliable shunt, and the inability to select those fetuses most likely to benefit from the procedure.  Based on our growing experience with spina bifida repair in utero, we felt the time was right to revisit this important issue. Using the same surgical approach to the fetus as in our spina bifida program, we are able to place a ventricular shunt in the same way it is placed in a newborn baby.  Perhaps even more importantly, we feel that recent developments in fetal imaging techniques and molecular diagnosis will allow us to operate only in those cases most likely
to result in an improved outcome.



Currently, intrauterine shunt therapy for hydrocephalus is an experimental procedure designed to investigate the potential for benefit.

Who is a candidate for intrauterine shunt therapy of hydrocephalus?

Fetuses with isolated hydrocephalus consistent with aqueductal stenosis.

Negative family history for hydrocephalus.

No other intra- or extra-cranial anomalies.

Progressive enlargement of the ventricles (>1.5 mm, at least 1 week between exams).

Evaluation prior to referral:

Targeted ultrasound to rule out other anomalies.

Maternal blood test to rule out infection with cytomegalovirus (CMV) or toxoplasmosis - both IgG and IgM.

Amniocentesis

Normal fetal chromosomes

Polymerase chain reaction (PCR) or culture for CMV and toxoplasmosis.

For further information:

Hydrocephalus Association

The Association for Spina Bifida and Hydrocephalus (England, Wales, Northern Ireland)

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The first fetal surgery to place a shunt in utero and ease some of the effects of hydrocephalus was performed by Dr. Noel Tulipan and Dr. Joseph Bruner at Vanderbilt . The Borkowski family underwent the first procedure of this kind in early 1999.

For more information about this surgery, contact our office at: (615) 343-5227 or e-mail Dr. Joseph Bruner joe.bruner@mcmail.vanderbilt.edu

The Borkowski's were featured on CBS This Morning July 15, 1999.

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