Abstract
OBJECTIVEHydrocephalus remains one of the most common congenital anomalies affecting the central nervous system, especially in developing countries. This study was conducted to determine the safety and efficacy of ventriculoamniotic shunt placement through a hysterotomy before the gestational age of 32 weeks.
METHODPreoperatively, all fetuses underwent a series of ultrasonographic examinations and magnetic resonance imaging to confirm the diagnosis of hydrocephalus. Samples of amniotic fluid were taken for several investigations. Between 2005 and 2007, 5 pregnancies with isolated fetal obstructive hydrocephalus before the gestational age of 32 weeks were treated at the King Fahd Hospital of the University using the Al-Anazi ventriculo-uterine shunt. Small hysterotomies were performed under the guidance of ultrasound and shunts were inserted without any difficulty.
RESULTSHysterotomies were performed at 31, 30, 28, 32, and 27 gestational weeks. Deliveries occurred at 31, 36, 35, 37, and 36 weeks, respectively. Shunts performed well during pregnancy and were at the right location and were intact at delivery. All patients experienced obstetrical and neonatal complications, which were not related to shunt insertion.
CONCLUSIONSAl-Anazi ventriculo-uterine amniotic shunt can be placed through a small hysterotomy, overcoming many of the technical difficulties of earlier trials. However, a team of dedicated and well-supported experts is needed for the double-blind, controlled, randomized studies of more cases to evaluate the safety and effectiveness of this shunt system.