What should I do if the left ventricle is enlarged

Enlargement of the left cerebral ventricle is often detected before prenatal check-ups. This sounds very frightening because it means that the baby in the belly has encountered such a problem. The results of this examination should be judged based on the actual situation. Some require recommendations to stop the pregnancy, while some are normal phenomena. 90% of fetal neurological development is normal.

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1. Prenatal Ultrasound Examination

The normal width of the lateral ventricle body is ≤10mm, with an average of 7mm, and remains basically unchanged between 14 and 40 weeks.

2. Other examinations

If ventriculomegaly is suspected during screening ultrasound, it should be carefully examined for other structural malformations or genetic markers. Such as chromosome karyotype analysis, TORCH virus screening, or MRI (magnetic resonance imaging) examination to help exclude central nervous system diseases.

Treatment principles

For children with combined structural abnormalities in other parts of the body or chromosomal abnormalities, it is not recommended to continue the pregnancy. After birth, a fetus with simple lateral ventriculomegaly should be examined again as soon as possible to confirm the diagnosis and find the cause. If there is still obvious ventriculomegaly, drainage surgery (ventriculoperitoneal drainage) should be performed in pediatric surgery as soon as possible. In infants with isolated ventriculomegaly, 90% have normal neurodevelopment. Their intellectual development is related to the early or late drainage surgery. 10% of children may have epilepsy, motor function or intellectual impairment. Fetuses with asymmetric ventriculomegaly, severe lateral ventriculomegaly, and progressive ventriculomegaly have poor long-term neurological development.

Causes and common diseases

Most of them are caused by excessive fetal cerebrospinal fluid and abnormalities of the central nervous system such as abnormal development of the midline brain structure or local space occupying space. It can also be an intracranial manifestation of abnormalities in other systems of the body, such as chromosomal abnormalities, viral infections, etc. The fetus produces about 650 ml of cerebrospinal fluid every day. Various reasons lead to an increase in the amount of cerebrospinal fluid in the ventricular system, and circulatory disorders can cause increased pressure in the ventricular system. The main causes include autosomal recessive gene and X-chromosome recessive gene abnormalities, cerebrospinal fluid circulation pathway disorders, viral infections and other reasons. Cerebral aqueduct stenosis is the most common cause.

Differential Diagnosis

1. Severe ventriculomegaly

A ventricular width of ≥15mm, also known as hydrocephalus, is caused by excessive accumulation of cerebrospinal fluid in the ventricular system, expansion of the lateral ventricular system, and increased pressure, which manifests as ventriculomegaly during ultrasound examination. Generally, a widening of the trigone of the lateral ventricle by 1.5 cm is considered ventricular enlargement, and the wider the area, the more serious the enlargement. If the triangle is 1.2 to 1.4 cm wide and the choroid plexus fills more than 50% of the ventricle, it is generally considered normal. If the choroid plexus is shrunk and becomes suspended, hydrocephalus is considered to be present.

2. Mild lateral ventriculomegaly

The diameter of the lateral ventricle is ≥10mm and ≤15mm. A lateral ventricle diameter of <10 mm is considered to be within the normal physiological range.

3. Isolated mild ventriculomegaly

Refers to cases in which no other abnormalities were found in systematic prenatal ultrasound examination. About 10% of fetuses with isolated mild ventriculomegaly have chromosomal abnormalities, the most common of which is trisomy 21. Viral infection during pregnancy, especially cytomegalovirus infection in late pregnancy, can also often lead to abnormal manifestations such as isolated ventriculomegaly and paraventricular mixed echoes.