Background Anomalies of the fetal central nervous system (CNS) require considerable expertise. In 2010 we launched a Perinatal Neurosurgical Clinic, wherein fetal CNS anomalies are assessed and counselled by a multi-disciplinary team, comprising a fetal medicine specialist, a paediatric neurosurgeon, a paediatric radiologist and a specialist nurse.
Materials and Methods A prospective review of all patients referred to our clinic from Jan 2010 to July 2012. All cases were triaged initially by a fetal medicine specialist to confirm diagnosis. If warranted, a fetal MRI was obtained prior to referral. Individual patient records were examined to determine pregnancy outcome.
Results Over the study period, 122 fetal CNS anomalies (excluding choroid plexus cysts) were seen. Of these, 41 women (34%) were referred to the Neurosurgical Clinic, including 1 case each of caudal regression syndrome, neuronal migration disorder, sacrococcygeal teratoma, AV malformation, agenesis corpus callosum, cerebellar hypoplasia and thoracolumbar gibbus (Table). Median gestation at referral was 30.5 weeks. Three women opted for termination. Of the remaining cases, 53% underwent fetal MRI. In 35%, MRI was considered to alter the diagnosis and counselling. 60% of women underwent caesarean delivery, at a median 38.8 weeks. Excluding 3 cases of holoprosencephaly, the perinatal mortality rate in this high risk cohort was 0%.
Conclusion A multi-disciplinary Perinatal Neurosurgical Clinic offers excellent potential, both in expert management of common CNS anomalies, such as neural tube defects, and in the assessment of much rarer fetal CNS anomalies.
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