# Hydrocephalus — GCMD Library living collection Everything in the library about hydrocephalus — built automatically from dossiers that name it. Updated: n/a · 5 episodes · 130 cited statements ## Episodes ### Surgical Management - [2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jesse Skoch](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234) — video · 19:51 · [machine version](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234.md) ### Evidence & Research - [2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Dawn Gano](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237) — video · 16:09 · [machine version](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237.md) - [2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239) — video · 16:09 · [machine version](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239.md) ### Case-Based Learning - [2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Hour 1 Q&A](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240) — video · 9:06 · [machine version](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240.md) ### Emerging & Future Directions - [IFMSS 2019 Techincal & Educational Innovation](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110) — podcast · 14:13 · [machine version](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110.md) ## Chapters - [0:03](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=3) Fetal ventriculoamniotic shunting for aqueductal stenosis: reviving a technique (Ep 1) - [5:04](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=304) Biodegradable synthetic dural patch for spina bifida repair (Ep 1) - [7:52](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=472) Real-time panoramic imaging software for twin-twin transfusion laser surgery (Ep 1) - [9:56](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=596) Patient-specific 3D-printed simulation models for fetoscopic spina bifida repair (Ep 1) - [0:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=0) Introduction and speaker handoff (Ep 2) - [0:16](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=16) Historical development of endoscopic third ventriculostomy (Ep 2) - [4:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=240) Modern ETV surgical technique demonstration (Ep 2) - [7:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=420) Age-dependent success rates and the ETV Success Score (Ep 2) - [11:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=660) Failure mechanisms and age-related challenges (Ep 2) - [13:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=780) Heterogeneity of aqueductal stenosis and neurologic outcomes (Ep 2) - [15:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=900) Safety comparison: ETV versus shunt dependency (Ep 2) - [17:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1020) Clinical decision-making framework for timing (Ep 2) - [18:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1110) Adjunctive techniques and future directions (Ep 2) - [0:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=0) Introduction and pathophysiology of obstructive hydrocephalus (Ep 3) - [3:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=180) Current postnatal treatments and rationale for prenatal intervention (Ep 3) - [6:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=360) Historical attempts at fetal hydrocephalus treatment and animal model development (Ep 3) - [9:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=540) Characterization of the fetal lamb hydrocephalus model (Ep 3) - [12:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=720) Fetal endoscopic third ventriculostomy technique and results (Ep 3) - [15:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=900) Human translation and future clinical trial plans (Ep 3) - [0:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=0) Introduction of Dr. Peiro (Ep 4) - [0:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=12) Pathophysiology of Obstructive Hydrocephalus and Current Diagnosis (Ep 4) - [4:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=240) Rationale for Prenatal Intervention (Ep 4) - [6:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=360) Historical Context of Fetal Hydrocephalus Treatment (Ep 4) - [8:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=480) Development of Fetal Lamb Hydrocephalus Model (Ep 4) - [10:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=600) Characterization of the Hydrocephalus Model (Ep 4) - [12:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=720) Fetal ETV Technique in Lamb Model (Ep 4) - [14:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=840) Results of Fetal ETV in Animal Model (Ep 4) - [15:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=900) Human Translation and Future Clinical Trial (Ep 4) - [0:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=0) Outcomes in isolated versus complex congenital aqueductal stenosis (Ep 5) - [1:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=110) Technical aspects and timing of fetal ETV (Ep 5) - [3:54](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=234) Timeline for human fetal ETV trials (Ep 5) - [4:44](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=284) Acetazolamide use and timing of postnatal intervention (Ep 5) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "Aqueductal stenosis is associated with poor neurologic outcomes" — Steven Emery (clinical) [Ep 1 · 0:30](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=30) - "In the 1980s fetal shunting for hydrocephalus was attempted but failed because accurate diagnosis of pressure hydrocephalus was not possible, leading to shunts being placed in babies with hydranencephaly, Dandy-Walker malformation, and other anomalies" — Steven Emery (clinical) [Ep 1 · 0:40](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=40) - "When the 1980s shunting data are scrutinized, babies who had aqueductal stenosis on postnatal evaluation actually benefited from shunting" — Steven Emery (clinical) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=90) - "IFMSS put a moratorium on fetal shunting in 1986" — Steven Emery (guideline) [Ep 1 · 1:50](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=110) - "Current management of fetal aqueductal stenosis is observation until near term (37 weeks) followed by assisted delivery, usually by cesarean section, sometimes classical cesarean with vertical skin incision due to large head size" — Steven Emery (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=120) - "The research team developed an animal model that reliably and reproducibly generates mid-trimester hydrocephalus and designed a shunt device from scratch that is near design freeze" — Steven Emery (clinical) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=150) - "Decompressing intracranial pressure with a shunt will allow the fetal brain to continue to develop normally and heal from injury that has already occurred" — Steven Emery (opinion) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=180) - "The research agenda presented in 2014 at IFMSS received phenomenal support from the investigators who instituted the 1986 moratorium, including Mike Harrison and Bill Kluwell" — Steven Emery (clinical) [Ep 1 · 3:35](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=215) - "The hydrocephalus shunt is purpose-designed specifically for fetuses, which is very unique in fetal medicine where devices are usually borrowed from other applications" — Steven Emery (opinion) [Ep 1 · 4:21](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=261) - "The MOMS trial demonstrated that in utero surgery for spina bifida, performed as early as possible, clearly improves outcomes in these babies" — Jose Piero (host_summary) [Ep 1 · 5:13](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=313) - "During in utero and postnatal spina bifida repair, it is very frequent not to have enough skin or dura for recovery of the lesions, requiring use of dural patches or substitutes" — Jose Piero (clinical) [Ep 1 · 5:30](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=330) - "Many dural substitute materials exist on the market but none is demonstrated to be ideal for spina bifida repair" — Jose Piero (clinical) [Ep 1 · 5:50](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=350) - "The Cincinnati team developed a patch using a blend of two FDA-cleared polymers (PEA-PCL) that is thin, can be coiled by body temperature, displays and uncoils automatically, is biodegradable, non-toxic, and spinal cord friendly" — Jose Piero (clinical) [Ep 1 · 6:05](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=365) - "The PEA-PCL patch is an acellular synthetic patch that disappears around one year and does not need to be removed" — Jose Piero (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=410) - "The patch development timeline from concept to market readiness is approximately 5 years, starting with in vitro testing, then in vivo testing in rats, then in fetal lambs" — Jose Piero (clinical) [Ep 1 · 7:18](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=438) - "During twin-twin transfusion syndrome laser ablation, the procedure is limited by a very limited field of view, making it hard for the surgeon to orient and navigate to find anastomoses" — Anuk van der Schot (clinical) [Ep 1 · 8:03](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=483) - "The Radboud team is creating a real-time panoramic view of the placental surface (a 'Google Maps for fetal surgery') to help surgeons make decisions and reduce complications associated with prolonged or incomplete surgery" — Anuk van der Schot (clinical) [Ep 1 · 8:30](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=510) - "The panoramic imaging algorithm uses only the visual information from the standard fetoscope without requiring extra hardware or sensors, similar to panoramic view on a phone camera" — Anuk van der Schot (clinical) [Ep 1 · 9:10](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=550) - "The panoramic imaging software could potentially work with any standard fetoscopy equipment and could be applied to other disciplines like bronchoscopy or laparoscopy" — Anuk van der Schot (opinion) [Ep 1 · 9:30](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=570) - "Fetoscopic spina bifida repair has many technical challenges in planning, preparation, and team training" — Gina Miller (clinical) [Ep 1 · 9:56](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=596) - "The Johns Hopkins team developed a modular 3D printing system to create patient-matched models for practice before each individual spina bifida case" — Gina Miller (clinical) [Ep 1 · 10:20](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=620) - "The 3D-printed models show very good visual correlation with the lesion at surgery and very high correlation with the number of sutures and how the repair actually goes" — Gina Miller (clinical) [Ep 1 · 10:50](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=650) - "The modular 3D printing system is very cheap and efficient, suitable for rapid prototyping that anyone can easily incorporate into clinical practice" — Gina Miller (opinion) [Ep 1 · 11:20](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=680) - "The workflow from ultrasound volume to 3D print takes a little over half an hour on a desktop printer, and surgical rehearsal is done with the core team within the week before surgery" — Gina Miller (clinical) [Ep 1 · 11:50](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=710) - "The rapid print uses standard ABS filament (hard material) or Ninja Flex (soft and flexible material)" — Gina Miller (clinical) [Ep 1 · 12:29](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=749) - "The team is close to completing standardization of the different components and has added features to the host model to make skin covering application easier and add the instability experienced in the OR" — Gina Miller (clinical) [Ep 1 · 13:11](https://library.globalcastmd.com/watch/ifmss-2019-techincal-educational-innovation-6110?t=791) - "The complex category in the Children's Hospital study included any case with any other anomaly, including genetic anomalies (aneuploidies, trisomy 13/18), extracranial findings, and syndromic findings, creating a heterogeneous group." (clinical) [Ep 5 · 0:47](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=47) - "Current counseling practice tends to combine isolated aqueductal stenosis cases (without suspected genetic cause) with complex cases in a broad-strokes approach, which may not be the appropriate approach." (opinion) [Ep 5 · 0:47](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=47) - "Conventional endoscopes for ETV are usually about 6 millimeters in diameter." (clinical) [Ep 5 · 2:07](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=127) - "For fetal ETV cases, 2.4 millimeter scopes are being used in clinical studies." (host_summary) [Ep 5 · 2:07](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=127) - "The fetal ETV scope is a 2.4 mm sharp-tip fetoscope with a 1.3 mm camera and a working channel, the same equipment used for placing tracheal balloons in CDH fetuses." (clinical) [Ep 5 · 2:22](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=142) - "The proposed gestational age for fetal ETV in phase one human studies is 24-25 weeks, following diagnosis around 20-21 weeks and genetic workup, similar to timing for spina bifida repair." (clinical) [Ep 5 · 3:11](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=191) - "Intervention between 25 and 30 weeks gestational age is considered acceptable for cases with delayed diagnosis, allowing time for brain recovery in utero." (opinion) [Ep 5 · 3:11](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=191) - "The fetal ETV trial requires an FDA IND (Investigational New Drug application) because it is a risky procedure, even though no drug is used and no device is left behind." (guideline) [Ep 5 · 4:03](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=243) - "The goal is to begin a pilot study for safety and feasibility of fetal ETV next year, involving collaboration between fetal surgery and neurosurgery teams." (clinical) [Ep 5 · 4:03](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=243) - "Acetazolamide can reduce CSF production by approximately 15% at best." (clinical) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "Acetazolamide may allow delaying intervention by one to two months in borderline, slowly progressing cases to reach a better category for ETV." (opinion) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "Acetazolamide has sufficient safety experience and electrolyte monitoring protocols to be used as a temporizing measure in appropriate patients." (clinical) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "Acetazolamide cannot be expected to be a game changer in rapidly progressing hydrocephalus cases." (opinion) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "Early postnatal ETV has a high failure rate in newborns with congenital aqueductal stenosis." (clinical) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "In a study by Rus, type 2 slowly progressive hydrocephalus patients treated with delayed ETV had the same neurologic outcomes as patients who were shunted earlier." (epidemiological) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "For stable postnatal patients not showing signs of rapid progression, there is no convincing data that earlier intervention is always better in a linear fashion." (opinion) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "For patients showing active progression with increasing pressure and damage, sooner intervention is better than waiting." (opinion) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "The primary benefit of fetal ETV may be developmental changes rather than preventing procedure failure, as many fetal ETV patients may still experience postnatal failure." (opinion) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=329) - "In postnatal treatment, the timing of intervention (earlier versus slightly later) is probably not as critical because the damage is already done and the condition is stable." (opinion) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=492) - "In fetal cases, timing is very critical because early intervention can potentially avoid pressure and allow better brain development." (opinion) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=492) - "The ETV fenestration can close in both neonates and fetuses, which is a concern for fetal intervention." (clinical) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=492) - "Maintaining decompression for 6-7 weeks in utero without pressure is beneficial even if postnatal redo ETV or shunt placement is needed, because the brain will have developed better." (opinion) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=492) - "The goal of fetal ETV is not to completely fix the hydrocephalus but to temporize and achieve better brain development, even if the intervention is temporary." (opinion) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-1-q-a-9240?t=492) - "CSF produced in the choroid plexus circulates through the ventricular system via the aqueduct of Sylvius and fourth ventricle, then around the brain for reabsorption." — Jose Peiro (clinical) [Ep 4 · 0:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=12) - "Aqueductal stenosis blocks normal CSF circulation, causing fluid buildup in lateral and third ventricles, representing a pure obstructive problem in fetuses and babies." — Jose Peiro (clinical) [Ep 4 · 1:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=60) - "Progressive ventricular enlargement in obstructive hydrocephalus causes increased intracranial pressure, cortical mantle thinning, rupture of septum pellucidum, and denudation of ependyma, producing problems in brain development." — Jose Peiro (clinical) [Ep 4 · 1:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=90) - "Ventriculomegaly and hydrocephalus can be detected very early in gestation using prenatal ultrasound, classified as mild, moderate, or severe." — Jose Peiro (clinical) [Ep 4 · 2:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=120) - "MRI is a very good tool to complete prenatal hydrocephalus evaluation and identify isolated aqueductal stenosis with genetic testing." — Jose Peiro (clinical) [Ep 4 · 2:20](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=140) - "Aqueductal stenosis is probably the most important cause of obstructive congenital hydrocephalus." — Jose Peiro (clinical) [Ep 4 · 3:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=180) - "Fetal hydrocephalus is associated with potentially poor outcomes including intellectual disabilities, spasticity, and seizures." — Jose Peiro (clinical) [Ep 4 · 3:20](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=200) - "Postnatal treatment of congenital hydrocephalus almost consistently requires CSF diversion, mostly with VP shunts, which have problems including malfunction and infection." — Jose Peiro (clinical) [Ep 4 · 3:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=220) - "Endoscopic third ventriculostomy can be performed postnatally to recirculate CSF as an alternative to shunting." — Jose Peiro (host_summary) [Ep 4 · 4:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=250) - "Any postnatal treatment probably arrives late because progressive brain deterioration occurs during the intrauterine period, including denudation, astrocytosis, and microgliosis." — Jose Peiro (opinion) [Ep 4 · 4:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=270) - "The first attempts at fetal hydrocephalus treatment were performed in fetal monkeys and chimp models using ventriculo-amniotic shunts approximately 40 years ago." — Jose Peiro (clinical) [Ep 4 · 6:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=360) - "The first human case of fetal hydrocephalus treatment was described by Birnholz, and 44 cases were collected in a registry and discussed at a 1982 fetal medicine and surgery meeting." — Jose Peiro (clinical) [Ep 4 · 6:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=390) - "Experts in fetal surgery decided on a moratorium on fetal hydrocephalus intervention after the 1982 meeting, likely due to suboptimal clinical outcomes and patient selection." — Jose Peiro (clinical) [Ep 4 · 7:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=420) - "Modern technology, better imaging, and genetic tools for patient selection make it sensible to reconsider fetal hydrocephalus treatment, specifically fetal ETV without hardware." — Jose Peiro (opinion) [Ep 4 · 7:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=450) - "In the fetal lamb model, kaolin injected into the cisterna magna creates moderate hydrocephalus but causes a meningitis-like irritation reaction." — Jose Peiro (clinical) [Ep 4 · 8:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=480) - "Comparing kaolin, bioglue, and onyx for creating fetal lamb hydrocephalus, bioglue was determined to be the best agent." — Jose Peiro (clinical) [Ep 4 · 9:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=540) - "A severity scale for fetal lamb hydrocephalus was developed with mild, moderate, and severe categories based on ventricular measurements." — Jose Peiro (clinical) [Ep 4 · 9:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=570) - "Only bioglue allowed creation of severe hydrocephalus cases in the fetal lamb model, with significant cortical thinning." — Jose Peiro (clinical) [Ep 4 · 10:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=600) - "The fetal lamb hydrocephalus model shows ependymal denudation with loss of cilia, likely due to ventricular distension." — Jose Peiro (clinical) [Ep 4 · 10:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=630) - "The percentage of ependymal denudation is higher with severe category hydrocephalus and occurs very early in gestation until delivery." — Jose Peiro (clinical) [Ep 4 · 11:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=660) - "Astrocytes replace ependymal cells and create scar tissue in areas of denudation." — Jose Peiro (clinical) [Ep 4 · 11:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=690) - "Activated microglia indicating neuroinflammation are present in areas of ependymal denudation, putting neuroprogenitor cells in the subventricular zone at risk of maldevelopment." — Jose Peiro (clinical) [Ep 4 · 11:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=710) - "Fetal ETV in the lamb model is performed using a 7 French rigid fetoscope or cystoscope inserted through the coronal suture approximately 1 centimeter to the midline to enter the lateral ventricle." — Jose Peiro (clinical) [Ep 4 · 12:20](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=740) - "The fetal lamb brain anatomy is more elongated than human, with a narrow foramen of Monro and other anatomical differences that create technical difficulties." — Jose Peiro (clinical) [Ep 4 · 13:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=780) - "In the fetal lamb model, the septum pellucidum is absent in hydrocephalus, allowing visualization of both lateral ventricles." — Jose Peiro (clinical) [Ep 4 · 13:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=810) - "The interthalamic adhesion in fetal lambs is very large, making the anatomy different from human." — Jose Peiro (clinical) [Ep 4 · 13:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=830) - "A rigid plastic fiber (laser without energy) is used to create a blunt opening in the third ventricle floor to avoid energy-related damage to the basilar artery in mid-gestation fetuses." — Jose Peiro (clinical) [Ep 4 · 14:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=850) - "Fetal ETV in the lamb model reduced ventricular size from severe to moderate-mild and from moderate to normal in most cases." — Jose Peiro (clinical) [Ep 4 · 14:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=880) - "Fetal ETV improved cortical thickness (reduced compression) in treated fetal lambs." — Jose Peiro (clinical) [Ep 4 · 15:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=910) - "In most cases, fetal ETV recovered ependymal denudation, though it is unknown whether this represents prevention or regeneration after ventricular deflation." — Jose Peiro (clinical) [Ep 4 · 15:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=930) - "A fetal surgeon in Brazil has performed percutaneous fetal ETV in 10 human cases with no deaths, demonstrating feasibility and safety." — Jose Peiro (clinical) [Ep 4 · 15:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=900) - "A multi-center U.S. clinical trial is planned, starting with phase 1 in 10 human cases to assess safety and feasibility, followed by phase 2 in 50-60 cases to assess efficacy." — Jose Peiro (clinical) [Ep 4 · 15:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jose-peiro-9239?t=940) - "CSF is produced in the choroid plexus and circulates through the ventricular system, through the aqueduct of Sylvius and fourth ventricle, around the brain for reabsorption." — Pero (clinical) [Ep 3 · 0:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=12) - "Aqueductal stenosis blocks normal CSF circulation and causes fluid buildup in the lateral and third ventricles, representing a pure obstructive problem in fetuses and babies." — Pero (clinical) [Ep 3 · 1:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=60) - "Progressive ventricular enlargement in obstructive hydrocephalus leads to increased intracranial pressure, cortical mantle thinning, rupture of the septum pellucidum, and denudation of the ependyma, causing problems in brain development." — Pero (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=90) - "Ventriculomegaly and hydrocephalus can be detected very early in gestation, with severity classified as mild, moderate, or severe." — Pero (clinical) [Ep 3 · 2:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=120) - "MRI is a very good tool to complete prenatal diagnosis and identify isolated aqueductal stenosis, along with genetic testing." — Pero (clinical) [Ep 3 · 2:20](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=140) - "Aqueductal stenosis is the most important cause of obstructive congenital hydrocephalus." — Pero (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=180) - "Fetal hydrocephalus is associated with potentially poor outcomes including intellectual disabilities, spasticity, and seizures." — Pero (host_summary) [Ep 3 · 3:20](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=200) - "Babies with congenital hydrocephalus almost consistently need CSF diversion, mostly with VP shunts, which have problems including malfunction and infection." — Pero (clinical) [Ep 3 · 3:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=220) - "Endoscopic third ventriculostomy can be performed postnatally to recirculate CSF as an alternative to shunting." — Pero (host_summary) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=250) - "Postnatal treatment of hydrocephalus probably arrives late because progressive brain deterioration occurs during the intrauterine period, including denudation, astrocytosis, and microgliosis." — Pero (opinion) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=270) - "The first attempts at fetal hydrocephalus treatment were in fetal monkeys using ventriculo-amniotic shunts approximately 40 years ago." — Pero (clinical) [Ep 3 · 6:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=360) - "The first human case of ventriculo-amniotic shunt was described by Birnholz almost 40 years ago." — Pero (clinical) [Ep 3 · 6:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=390) - "A registry collected 44 cases of ventriculo-amniotic shunts, and results discussed at a 1982 fetal medicine and surgery meeting led experts to declare a moratorium on this intervention due to inadequate clinical outcomes and patient selection." — Pero (clinical) [Ep 3 · 6:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=410) - "After 40 years, improved technology, imaging, and genetic tools for patient selection make it reasonable to reconsider fetal hydrocephalus treatment, but using ETV rather than shunts." — Pero (opinion) [Ep 3 · 7:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=450) - "In the fetal lamb model, kaolin injected into cisterna magna creates hydrocephalus but produces a meningitis-like irritation reaction." — Pero (clinical) [Ep 3 · 8:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=480) - "Comparing kaolin, onyx, and bio-glue as agents to create hydrocephalus in fetal lambs, bio-glue was determined to be the best." — Pero (clinical) [Ep 3 · 9:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=540) - "Bio-glue was the only agent that allowed creation of severe hydrocephalus cases in the fetal lamb model." — Pero (clinical) [Ep 3 · 9:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=570) - "Brain thinning was more significant with bio-glue compared to other agents in the fetal lamb hydrocephalus model." — Pero (clinical) [Ep 3 · 9:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=590) - "The fetal lamb hydrocephalus model shows ependymal denudation with loss of cilia, likely due to ventricular distension." — Pero (clinical) [Ep 3 · 10:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=610) - "The percentage of ependymal denudation is higher with more severe hydrocephalus in the fetal lamb model." — Pero (clinical) [Ep 3 · 10:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=640) - "Ependymal denudation occurs very early in gestation and persists until delivery in the fetal lamb model." — Pero (clinical) [Ep 3 · 11:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=660) - "Astrocytes replace ependymal cells and create scar tissue in areas of denudation in the hydrocephalus model." — Pero (clinical) [Ep 3 · 11:20](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=680) - "Activated microglia indicating neuroinflammation is present in areas of ependymal denudation, putting neuroprogenitor cells in the subventricular zone at risk of maldevelopment." — Pero (clinical) [Ep 3 · 11:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=700) - "A 7 French rigid fetoscope or cystoscope was used to perform fetal ETV in the lamb model after trying different scopes including a yellow scope." — Pero (clinical) [Ep 3 · 12:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=720) - "The entry point for fetal ETV in lambs is at the coronal suture on the right side, approximately 1 centimeter to the midline to enter the ventricle." — Pero (clinical) [Ep 3 · 12:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=750) - "Fetal ETV can be performed transuterine without opening the uterus in the lamb model." — Pero (clinical) [Ep 3 · 12:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=770) - "The fetal lamb brain anatomy is more elongated than human, with a narrower foramen of Monro, creating technical difficulties for fetal ETV." — Pero (clinical) [Ep 3 · 13:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=790) - "In the fetal lamb model, there is no septum pellucidum, allowing visualization of both sides of the lateral ventricles." — Pero (clinical) [Ep 3 · 13:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=810) - "The interthalamic adhesion is very large in fetal lambs, making the anatomy different from humans." — Pero (clinical) [Ep 3 · 13:50](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=830) - "A rigid plastic fiber (a laser without energy) is used to create a blunt opening in the third ventricle floor to avoid damaging the basilar artery in mid-gestation fetuses." — Pero (clinical) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=850) - "In twin fetal lambs with the same degree of ventriculomegaly, the one treated with fetal ETV had thicker brain tissue and smaller ventriculomegaly at delivery compared to the untreated twin." — Pero (clinical) [Ep 3 · 14:40](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=880) - "Fetal ETV in the lamb model can reduce ventricular size from severe to moderate-mild and from moderate to normal." — Pero (clinical) [Ep 3 · 15:10](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=910) - "Fetal ETV can improve cortical thickness in the fetal lamb hydrocephalus model." — Pero (clinical) [Ep 3 · 15:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=930) - "In most cases in the lamb model, fetal ETV recovered ependymal denudation, though it is unknown whether this represents prevention or regeneration after ventricular deflation." — Pero (clinical) [Ep 3 · 15:45](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=945) - "A fetal surgeon in Brazil has begun performing fetal ETV in humans percutaneously with a sharp-tip cystoscope and has published 10 cases." — Pero (clinical) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=900) - "Fetal ETV is feasible in both fetal lambs and humans." — Pero (clinical) [Ep 3 · 15:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=930) - "Fetal ETV is safe with no deaths reported in the Brazilian series of 10 human cases." — Pero (clinical) [Ep 3 · 15:45](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=945) - "Plans exist for a multi-center US clinical trial with phase one enrolling 10 cases to assess safety and feasibility, followed by phase two enrolling 50-60 cases to assess efficacy." — Pero (clinical) [Ep 3 · 16:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-dawn-gano-9237?t=960) - "Congenital aqueductal stenosis accounts for 5-20% of congenital hydrocephalus etiology, with approximately 600-1500 cases per year in the United States." — Jesse Skoch (epidemiological) [Ep 2 · 0:16](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=16) - "Walter Dandy in the 1920s used a crude cystoscope to burn choroid plexus in hydrocephalic patients, with 24 out of 25 patients dying of complications." — Jesse Skoch (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=120) - "Dr. Mixer in 1923 is credited with the modern version of ETV involving fenestration of the floor of the third ventricle using a urethroscope." — Jesse Skoch (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=180) - "Scarf et al. in 1936 published a series of 20 ETV cases with 10 showing long-term improvement, 7 failures, and 3 immediate post-surgical deaths." — Jesse Skoch (clinical) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=210) - "ETV technology reached its modern form in the 1980s with advances in camera and endoscope technology, after being relatively quiescent from the mid-1930s due to the invention of VP shunt pressure-regulated valves in the 1950s." — Jesse Skoch (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=240) - "Serial slow dilation with balloon catheters (such as 3 French Fogarty catheters) can successfully open the majority of the accessible floor of the third ventricle, even in patients with narrow third ventricles." — Jesse Skoch (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=300) - "Making the ETV ostomy as large as possible is important in young children because it helps fight against closure in the growing infant brain." — Jesse Skoch (opinion) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=360) - "The ETV Success Score assigns 30 points for aqueductal stenosis etiology and 50 points for age greater than 10 years, with points translating directly to percentage success rates." — Jesse Skoch (clinical) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=540) - "Patients with aqueductal stenosis who are greater than 10 years old have an 80% chance of ETV success, while those less than 1 month old have success rates in the 30-50% range." — Jesse Skoch (clinical) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=600) - "ETV procedures carry risks including hemorrhage, injury to the basilar artery, damage to the fornix (which can cause memory loss), and procedure failure." — Jesse Skoch (clinical) [Ep 2 · 10:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=630) - "Successful ETV patients typically do not show the same degree of ventricular reduction as shunted patients, but developmental outcomes can be very good." — Jesse Skoch (clinical) [Ep 2 · 12:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=720) - "A visible CSF jet stream (appearing black on sagittal MRI) through the ETV ostomy is a reassuring sign of patency, though not required for success." — Jesse Skoch (clinical) [Ep 2 · 12:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=750) - "ETV failures occur through four mechanisms: ostomy closure, ostomy narrowing, patent ostomy with membrane formation elsewhere in the third ventricle or basilar cisterns, or insufficient CSF diversion possibly due to mixed communicating hydrocephalus." — Jesse Skoch (clinical) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=780) - "The Toronto group's large study showed that infants less than 1 month old fare poorly with ETV outcomes over time, with a big improvement in success rates at the 6-month age mark." — Jesse Skoch (host_summary) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=840) - "Mohammadi et al. showed that pre-term versus post-term status makes a significant difference in ETV outcomes, with corrected age being important to consider in premature babies." — Jesse Skoch (host_summary) [Ep 2 · 14:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=870) - "According to Rhodes et al., congenital acute aqueductal stenosis (big ventricles from birth with progression) has better neurologic outcomes with shunting than with ETV, while chronic slowly progressive hydrocephalus shows no difference between procedures." — Jesse Skoch (host_summary) [Ep 2 · 15:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=900) - "A 2011 meta-analysis showed ETV has a permanent morbidity rate of 2.4% and mortality of 0.21%." — Jesse Skoch (host_summary) [Ep 2 · 16:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=990) - "Shunting has an in-hospital mortality of 0.3-0.8%, but Norwegian longitudinal studies over 40 years showed 48% overall mortality with 8% attributed to shunt failures and shunt-related issues." — Jesse Skoch (host_summary) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1020) - "If an ETV works and shows success at 6 months to 1 year, very few patients will have long-term delayed complications, unlike the constantly ticking time bomb of shunt dependency." — Jesse Skoch (clinical) [Ep 2 · 17:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1050) - "If a clinician is not comfortable letting a patient go for two weeks without follow-up ultrasound or examination, that is a red flag warning sign that the patient needs shunting rather than continued observation." — Jesse Skoch (opinion) [Ep 2 · 18:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1080) - "Stented ETV using hardware to hold the ostomy open has not panned out well because foreign body reactions can occur at any time in the patient's life, similar to shunt failures." — Jesse Skoch (clinical) [Ep 2 · 18:30](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1110) - "Dr. Warf's sub-Saharan African study showed a 30% improvement in ETV success when combined with choroid plexus cauterization, but meta-analysis of other published studies has not replicated those numbers in larger datasets." — Jesse Skoch (host_summary) [Ep 2 · 19:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-dr-jesse-skoch-9234?t=1140) ## Changelog - Sep 25: 5 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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