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Suggest Treatment For Severe Ventriculomegaly/mild Hydrocephalus In Fetus

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Posted on Mon, 9 Mar 2015
Question: Hi, our son was just prenatally diagnosed at 35 weeks with severe ventriculomegaly/mild hydrocephalus. Doctors say there are 4cm of fluid in the left ventricle - the right ventricle appears normal. An amnio. cleared possibilities of Downs/Trisomy 18. His head has always measured ahead of normal. Doctors measured both of our heads and we are in the upper average range so we weren't too concerned. He has had a few bumps in the road with a slight kidney dilation and chorid plexus cyst at 1.1mm that had all dissolved by 29 weeks. We were shocked that something so big could have happened once he finally had the all clear. The only reason we found out about the problem was a size check-in. His estimated weight is 8 1/2 pounds at almost 36 weeks. Surgery was mentioned for a shunt, developmental disabilities from slight to severe, etc. I have been researching and am wondering the chances of a simple cyst? Any help would be appreciated!
doctor
Answered by Dr. Shoaib Khan (1 hour later)
Brief Answer:
If MRI or CT used, a simple cyst would have been diagnosed

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I am sorry to hear about the ventriculomegaly diagnosed in your son, but there are a few things I would like to explain if you do not mind.

1. Disabilities are usually only seen in those children who have associated abnormalities and the specific cause for the ventriculomegaly. But in most cases, especially those with simpler causes the child develops normally, without any sign of abnormality or difficulty

2. Causes for ventriculomegaly are the following:

+Infections (e.g. CMV and toxoplasmosis)
+Agenesis of the corpus callous (varying prognosis from mild-moderate prognosis)
+Chiari II malformation
+Aqueductal stenosis (moderate prognosis)
+Dandy-Walker continuum: There is a cyst present in this condition, and it carries a poor prognosis unfortunately

So it is important to find the specific cause in your sons case, after which we can predict the prognosis.

Now coming to your query ma'am, a brain cyst can of course present in children which can be diagnosed pre-nasally, but the diagnosis and characteristic features would vary from that of ventriculomegaly. Ventriculomegaly has its specific causes as I have listed above, and each of these causes has a specific presentation and their own features.

For this reason it is important to learn more about the cause, and its aetiology. I completely understand your condition ma'am, and please do not ever lose hope. Learn more about your son, ask questions, study the reports of all investigations conducted, and so on.

For anything you do not understand, I am always here to help. I hope I have explained things in a manner best understood by you. Please feel free to write back to me for any further clarifications, I am always here.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan (2 hours later)
Thanks for your response. I looked up most of what you said and I am hopeful that nothing seems to fit. The doctors are unsure of what it could be. They are doing a microarray to see if it's x-linked, etc. He seems to have no other anomalies such as cleft palate, heart defect, etc. Which seems hopeful as well.

Does it seem positive or negative that it occurred post 29 weeks since his brain had more time to develop 'normally'? Is it also a good sign that it is isolated to the left side of the brain and not symmetrical?

The only good news the doctors were confident of was that if he was going to have an incident to his brain it is better to happen when he is so young to potentially repair itself/compensate versus later in life...
doctor
Answered by Dr. Shoaib Khan (8 minutes later)
Brief Answer:
Yes; yes; and yes

Detailed Answer:
Hello once again ma'am.

I would first like to say that I really admire your will to learn more on the topic, you are even beginning to think on the level of a medical personnel.

In response to your questions individually:

+Yes, it is a indeed a positive sign that your son did have at least (hopefully) 29 weeks for his brain to develop. But I would like to point out two things here:
1. We are unsure about exactly when the cause for his ventriculomegaly developed, as we only stumbled upon the diagnosis
2. The brain continues to develop not only till birth, but even after that. So sadly, he will still be at a risk of poor development

+It is a positive tick on the good prognosis side of the chart that the ventriculomegaly is restricted to one side only

+Yes, which is the main reason why most cases with ventriculomegaly (and absent associated anomalies) can go on to live a completely normal life

I hope I have explained things in a manner best understood by you. Please do not hesitate to write to me about anything, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan (16 hours later)
Thank you once again. One last question: Is it possible that the size of the ventricle can shrink? Just trying to mentally prepare ourselves for our ultrasound this week.
doctor
Answered by Dr. Shoaib Khan (1 hour later)
Brief Answer:
It was my pleasure entirely, look forward to good news

Detailed Answer:
Hello once again ma'am.

If at all the cause for the enlargement of the ventricle was a self-limiting one (i.e. it will resolve on its own), then we can slowly start expecting it to subside, in turn causing the ventricle to shrink back to its normal size.

I am hopeful, and trust me I have prayed for your son and shall continue doing. Please do not ever hesitate to write to me for any clarifications, or any difficulties you have understanding anything, I shall do all I can within my capabilities to help, I assure you that.

Best of luck ma'am,

God bless your family.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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Suggest Treatment For Severe Ventriculomegaly/mild Hydrocephalus In Fetus

Brief Answer: If MRI or CT used, a simple cyst would have been diagnosed Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. I have gone through your query with diligence and would like you to know that I am here to help. I am sorry to hear about the ventriculomegaly diagnosed in your son, but there are a few things I would like to explain if you do not mind. 1. Disabilities are usually only seen in those children who have associated abnormalities and the specific cause for the ventriculomegaly. But in most cases, especially those with simpler causes the child develops normally, without any sign of abnormality or difficulty 2. Causes for ventriculomegaly are the following: +Infections (e.g. CMV and toxoplasmosis) +Agenesis of the corpus callous (varying prognosis from mild-moderate prognosis) +Chiari II malformation +Aqueductal stenosis (moderate prognosis) +Dandy-Walker continuum: There is a cyst present in this condition, and it carries a poor prognosis unfortunately So it is important to find the specific cause in your sons case, after which we can predict the prognosis. Now coming to your query ma'am, a brain cyst can of course present in children which can be diagnosed pre-nasally, but the diagnosis and characteristic features would vary from that of ventriculomegaly. Ventriculomegaly has its specific causes as I have listed above, and each of these causes has a specific presentation and their own features. For this reason it is important to learn more about the cause, and its aetiology. I completely understand your condition ma'am, and please do not ever lose hope. Learn more about your son, ask questions, study the reports of all investigations conducted, and so on. For anything you do not understand, I am always here to help. I hope I have explained things in a manner best understood by you. Please feel free to write back to me for any further clarifications, I am always here. Best wishes.