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
Who is a candidate for intrauterine shunt
therapy of hydrocephalus?
Fetuses with isolated
hydrocephalus consistent with aqueductal stenosis.
Negative family history for
No other intra- or
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.
Normal fetal chromosomes
Polymerase chain reaction (PCR) or culture for CMV
For further information:
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
The Borkowski's were featured on CBS
This Morning July 15, 1999.