Management of intrauterine hydrocephalus

✓ The aggressive treatment of hydrocephalus has been of benefit to many children. Sophisticated two-dimensional ultrasound techniques allow the diagnosis of prenatal hydrocephalus to be made with accuracy and ease. In the past, the medical decisions governing the management of hydrocephalus in utero were made by obstetricians and were directed at reducing maternal mortality and morbidity. Now, with improved diagnosis and support facilities for the newborn, neurosurgical input is being requested as more concern is expressed for the fetus. Based on their experience with seven cases of intrauterine hydrocephalus in the past 3 years, the authors present their program for the management of this problem. If antenatal ultrasonography shows hydrocephalus without other anomalies, they recommend that the fetus be born by elective Caesarean section at the time of pulmonary maturity, and that early ventricular shunting be carried out. This plan should minimize nervous system trauma resulting from hydrocephalus and the birth process. If, however, antenatal diagnostic studies show cerebral or other major system anomalies in addition to hydrocephalus, then standard obstetrical care should be given. Antenatal ultrasonography has been found to be reliable in assessing fetal lateral ventricular size and shape, and to correlate well with the results of postnatal computerized tomography scanning.