단독 태아 경뇌실확장증의 임상적 예후 = The Developmental Outcome of Fetal Mild Isolated Ventriculomegaly

다국어 초록 (Multilingual Abstract)

Purpose : This study is directed to evaluate standardized developmental test performances of infants and children who, as fetuses, had mild isolated cerebral ventriculomegaly diagnosed by ultrasound.
Methods : All prenatal sonographic findings from 2001 to 2002 were evaluated. Live isolated mild ventriculomegaly(IMVM) of 10-15 mm were observed in 95 cases(1.1 percent). Standardized developmental testing of 40 cases of IMVM and 36 cases in a comparison group were offered to parents Both groups of children were adjusted to normal antepatum subjects with respect to sex, race, indication for ultrasound and gestational age at the time of ultrasound. Test of cognitive and motor development(Bayley Scales of Infant Development, Second Edition; BSID-II) were administered by developmental examiners.
Results : Forty cases and 34 comparison sujects completed the testing. The IMVM and comparison groups were similar with respect to parental age, gestational age, birth weight, familial socioeconomic status. The IMVM subjects scored lower than the comparison group on both the BSID-II, but there was not statistically significant. differences; metal development index(MDI)(92.7±12.9 vs 94.7±14.1, P=0.47) and psychomotor development index(PDI)(100.3±14.1 vs 101.3±10.7, P=0.75). Eleven cases(27.5 percent) of IMVM group and five cases(14.7 percent) of the comparison group were developmentally delayed, but most cases in both groups showed mild delays. Resolution or lack of progression, lateral ventricle diameter ≤12 mm and females were associated with better scores, but there were not statistically significant. Polarity, and head circumference were not related to later development.
Conclusion : This study show children with MIVM did not delay performance in the developmental test, but we might suggest a tendency to increase the risk of mild developmental delay.

국문 초록 (Abstract)

목 적 : 객관적이고 표준화된 검사(BSID-II)를 통해 단독 태아 경뇌실확장증의 임상적 예후를 알아보고자 하였다.방 법 : 2001년 6월부터 2002년 5월까지 본원에서 출생한 만삭아중 산전 초음파에서 다른 동반 기형이 없는 10-15 mm 정도의 단독 경뇌실확장증의 소견은 107례에서 관찰할 수 있었으며, 이 중 외래에서 추적 관찰이 가능하였던 40명과, 성별, 연령, 임신주수, 출생체중이 유사한 대조군 34명을 대상으로 발달 검사를 시행하였고 그 결과를 비교 분석하였다.결 과 : 단독 경뇌실확장증군 40명 중 남아가 21명, 여아가 19명이었고, 12 mm 미만은 35명, 12 mm 이상은 5명이었다. 산전 혹은 출생 후 초음파 추적 관찰시 감소되거나 그대로인 경우가 35명, 진행된 경우가 5명이었고, 일측성 뇌실확장이 25명, 양측성인 경우가 15명이었다. 단독 경뇌실확장군 중 발달지연은 11명(27.5%)이었고 이 중 경미한 발달지연은 10명(25%), 의미있는 심한 발달지연은 1명(2.5%)이었고 대조군 중 경미한 발달지연은 5명(14.7%), 심한 발달지연은 1명(2.9%)이었으며 발달지연을 보인 단독 경뇌실확장군의 91%와 대조군의 80%가 경미한 발달지연이었다. 단독 경뇌실확장군의 발달 검사 평균점수는 대조군과 유의한 차이를 보이지 않았다; MDI(92.75±12.95 vs 94.71±14.14, P=0.47), PDI(100.33±14.14 vs 101.27±10.70, P=0.75). 뇌실확장이 소실되거나 진행되지 않는 경우, 뇌실 크기가 12 mm 이하, 그리고 여아인 경우 발달 검사 평균점수는 더 높았으나 통계적으로 유의하지 않았고, 양측성과 일측성의 여부는 발달 정도와 관련이 없었다. 결 론:산전 초음파 검사에서 단독 경뇌실확장증을 보인 경우 발달 검사에서 정상 대조군과 비교하여 유의한 차이를 보이지 않았으나 단독 경뇌실확장증이 있는 경우 경미한 발달지연의 위험성을 보일 경향이 더 높은 것으로 생각된다.

참고문헌 (Reference)

1 "editors. Diseases of the fetus and newborn. London" Chapman and Hall 414-63, 1994

2 "Zuccollo J. The outcome of fetal ventriculomegaly. Br J Radiol 1994" 26-31,

3 "Vintzileos AM. Outcome of prenatally diagnosed mild unilateral cerebral ventriculomegaly." 20 : 257-62, 2001

4 "Ville Y. Prenatal diagnosis and follow-up of 14cases of unilabteral ventriculomegaly. Ultrasound Obstet Gynecol 1999" 14 : 327-32,

5 "Twickler DM. The developmental outcome of children with antenatal mild isolated ventriculomegaly. Obstet Gynecol 1997" 90 : 93-7,

6 "Stewart WB. Association of chronic sublethal hypoxia with ventriculomegaly in the developing rat brain. Brain Res Dev Brain Res 1998" 111 : 197-203, 1998

7 "Srivastava LK. NCAM-180 knockout mice display increased lateral ventricle size and reduced prepulse inhibition of startle. Neuroreport 1998" 9 : 461-6, 1998

8 "Reassessment of normal values for atrial diameter at ultrasound. Radiology 1994" 409-11,

9 "Outcome in children with fetal mild ventriculomegaly : a case series. Schizophr Res" 48 : 219-26,

10 "Naides SJ. Diagnosis of fetal infection in the patient with ultasonography detected abnotmality but a negative clinical history. Am J Obstet Gynecol 1993" 6-11,

11 "Mack LA. Mild idiopathic lateral cerebral ventricular dilatation in utero" 715-21,

12 "Kim A. The clinical outcome of isolated mild fetal ventriculomegaly. Korean J Obstet Radiol 1999" 1 : 46-51,

13 "Isolated mild fetal cerebral ventriculomegaly : A retrospective analysis of 26 cases" 21 : 589-95, 2001

14 "Is there a correlation with fetal trisomy" 89-92, ultrasoundobstetgynecol1993

15 "Filly RA. Exclusion of fetal ventriculomegaly with a single measurement The width of the lateral ventricular atrium. Radiology 1988" 711-4,

16 "Fetal serum interferon-alpha suggests viral infection as the aetiology of unexplained lateral cerebral ventriculomegaly" 16 : 883-92,

17 "Fetal cerebral ventricular atrium: Difference in size according to sex." 713-5, 1995

18 "Clinical outcome of mild fetal ventriculomegaly." 178 : 218-22, 1998

19 "Clinical outcome of fetal mild ventriculomegaly. Korean J Obstet Gynecol" 43 : 2248-53, 2000

20 "Bovicelli L. The clinical significance of fetal isolated cerebral borderline ventriculomegaly Report of 31 cases and review of the literature. Ultrasound Obstet Gynecol 1999" 14 : 320-6, 1999

21 "Bayley N. Bayley scales of infant development. 2nd ed. San Antonio" Harcourt Brace and Company 1993.

22 "Achiron R. Outcome of fetus with isolated borderline unilateral ventriculomegaly diagnosed at mid-gestation. Ultrasound Obstet Gynecol 1998" 23-6,

23 "Abnormalities in neuronal process extension, hipocampal development, and the ventricular system of L1 knockout mice" 19 : 4907-20, 1999