Fetal Neurosurgery Babak Babapour, M.D., PhD Sami Hussein, M.D., PhD Germany / Iran

Fetal neurosurgery ceased in 80s before it realy began Perspective Classification of Congenital Hydrocephalus (PCCH) based on stage, type and clinical categories by Oi et al Stage II of PCCH describes the period spanning 22-31 Weeks of gestation, when the pulmonary maturation is not Completed :. most relevant period for fetal surgical considerations 6-An can cause different morphological changes applied At different period of life, so that it is very reliable model for Perinatal noncommunicating hydrocephalus and also For neonatal communicating hydrocephalus

Hydrocephalus Exessive intracranial accumulation of CSF due to dysorders in production, circulation or resorption

Pathophysiology of hydocephalus from proximal to distal in CSF-Pathway Lateral ventricle

Foramen Monroi

third Ventrikel Aqueduct

Non communicating Hydrocephalus Huge Arachnoidcyst of posterior fossa and occlusion of lateral recessus : Non communicating Hydrocephalus Huge Arachnoidcyst of posterior fossa and occlusion of lateral recessus : Non communicating Hydrocephalus

IV Cyst

Stadieneinteilung v. Hydrozephalus n Stadieneinteilung v. Hydrozephalus n. klinischen postshuntklassifikation

Typeinteilung v. postshunt isol Typeinteilung v. postshunt isol. Kompartimenten in kommunizierendem Neuralkanal

Koronares kranielles Präparat eines Koronales kranielles Präparat eines 6-AN- Fetus am 19.Tag (3,87 fache Vergrößerung): Hypoplasie des Plexus choroideus, des Corpus callosum, Cerebellum. Erweiterung des gesamten Ventrikelsystems bei reduziertem Hirnparenchym Koronares kranielles Präparat eines Kontrollfetus am 19.Tag (3,87 fache Vergrößerung)

Intrauterinary sonography

Intrauterinärer Sonographiebefund eines Kontroll-Tires vom 20 Intrauterinärer Sonographiebefund eines Kontroll-Tires vom 20. Gestationstag.

Man sieht deutlich, daß der ICP und der IAP bei den hydrozephalen Tieren sehr ähnlich ist, und nahe beieinander liegen, bei Kontroll-Tieren ist der IAP höchst-signifikant höher als der ICP. Der IPP ist bei den Kontroll-Tieren signifikant höher als der ICP. Der IPP ist sogar bei hydrozephalen Tieren höher als der ICP, jedoch nicht signifikant.

Conclusion: Stage II of PCCH describes the period spanning 22-31 Weeks of gestation, when the pulmonary maturation is not Completed :. most relevant period for fetal surgical considerations Since the failure of the first trial of fetal neurosurgery in the 80s, the prerequisites have not been clarified. The goal of our experimental and clinical works was to obtain backgrounds and prerequisites for a stronger future for fetal surgery Our Impression is that the reason for the failure of fetal shunt systems Lies in the pressure dynamics of the maternal and fetal cavities, as well as the associated malformation, if any. The fetal hydrocephalus is of a High pressure type and surrounded by extremely high intrauterine and maternal intraperitoneal pressure We are convinced that the final status, including psych functional Prognosis, which may vary from case to case in congenital hydrocephalus is so that the correct decision regarding the management can be carried out in a medico-ethical committe involving the parents

Multidisciplinary cooperative team work