Bs. Hertzberg et al., CHOROID-PLEXUS VENTRICULAR WALL SEPARATION IN FETUSES WITH NORMAL-SIZED CEREBRAL-VENTRICLES AT SONOGRAPHY - POSTNATAL OUTCOME, American journal of roentgenology, 163(2), 1994, pp. 405-410
OBJECTIVE. The choroid plexus typically fills the atrium of the latera
l ventricles of the brain in normal fetuses, but separates from the me
dial ventricular wall with increasing ventriculomegaly. Sonographic de
piction of choroid plexus-ventricular wall separation has been associa
ted with a high frequency of unfavorable outcomes in fetuses with mild
ventricular dilatation. This separation, however, is also observed in
a small subgroup of fetuses with normal ventricular measurements. The
objective of this study was to ascertain the prognosis for fetuses wh
en choroid plexus-ventricular wall separation and normal-sized lateral
ventricles are seen on antenatal sonograms. MATERIALS AND METHODS. Po
stnatal follow-up was reviewed for 74 fetuses showing a 3 mm or greate
r separation between the choroid plexus and the medial ventricular wal
l and normal-sized (less than or equal to 10 mm) ventricles on antenat
al sonograms. Fetuses were divided into normal and abnormal outcome gr
oups, and the data were analyzed to determine if the amount of separat
ion, the ventricular atrial diameter, or the evolution of these findin
gs on follow-up sonograms was predictive of outcome. RESULTS. Fifty-ni
ne patients (80%) had normal outcomes (defined as no congenital anomal
ies and no significant subsequent medical history apart from usual inf
ant and childhood illnesses) and 15 patients (20%) had abnormal outcom
es. The severity of the abnormalities varied widely ranging from relat
ively inconsequential, such as isolated polydactyly, to complex congen
ital malformation syndromes resulting in neonatal death. No consistent
pattern of malformation was evident. Although we found a statisticall
y significant difference in the degree of choroid plexus-ventricular w
all separation when fetuses were separated into normal and abnormal ou
tcome groups, the range of measurements obtained in these two populati
ons overlapped considerably. Outcomes were normal in all 13 patients i
n whom the choroid plexus-ventricular wall separation had returned to
normal by the time of the last antenatal sonogram. CONCLUSION. A separ
ation of 3 mm or greater between the choroid plexus and the medial ven
tricular wall is an important finding that is associated with an incre
ased risk of an abnormal outcome even in the subpopulation of fetuses
with normal-sized ventricles. Although the outcome will be normal in t
he majority (80%) of such fetuses, identification of choroid plexus-ve
ntricular wall separation mandates a meticulous examination of fetal a
natomy.