MRI is increasingly employed to assess intrauterine fetal anomalies. Central nervous system (CNS) anomalies are common structural conditions that warrant evaluation with fetal MRI and subsequent prenatal consultation with a pediatric neurosurgeon. As the use of fetal MRI increases, there is greater impetus to understand the most common CNS structural anomalies diagnosed in utero, as well as their natural histories.

The authors performed a single-center retrospective review of fetal MRI evaluations performed between January 2012 and December 2020. Children who underwent both prenatal and postnatal neurosurgical evaluations of CNS anomalies were included. Specific CNS anomalies on fetal MRI, associated extra-CNS findings, and suspicion for genetic abnormality or syndromes were noted. Postnatal clinical status and interventions were assessed.

Between January 2012 and December 2020, a total of 469 fetal MRI evaluations were performed; of these, 114 maternal-fetal pairs had CNS anomalies that warranted prenatal consultation and postnatal pediatric neurosurgical follow-up. This cohort included 67 male infants (59%), with a mean ± SD follow-up of 29.8 ± 25.0 months after birth. Fetal MRI was performed at 27.3 ± 5.8 weeks of gestational age. The most frequently reported CNS abnormalities were ventriculomegaly (57%), agenesis or thinning of the corpus callosum (33%), Dandy-Walker complex (DWC) (21%), neuronal migration disorders (18%), and abnormalities of the septum pellucidum (17%). Twenty-one children (18%) required neurosurgical intervention at a mean age of 2.4 ± 3.7 months. The most common surgical conditions included myelomeningocele, moderate to severe ventriculomegaly, encephalocele, and arachnoid cyst. Corpus callosum agenesis or thinning was associated with developmental delay (p = 0.02) and systemic anomalies (p = 0.05). The majority of prenatal patients referred for DWC had Dandy-Walker variants that did not require surgical intervention.

The most common conditions for prenatal neurosurgical assessment were ventriculomegaly, corpus callosum anomaly, and DWC, whereas the most common surgical conditions were myelomeningocele, hydrocephalus, and arachnoid cyst. Only 18% of prenatal neurosurgical consultations resulted in surgical intervention during infancy. The majority of referrals for prenatal mild ventriculomegaly and DWC were not associated with developmental or surgical sequelae. Patients with corpus callosum abnormalities should be concurrently referred to a neurologist for developmental assessments.

MRI 越来越多地用于评估宫内胎儿异常。中枢神经系统 (CNS) 异常是常见的结构状况，需要通过胎儿 MRI 进行评估，并随后与儿科神经外科医生进行产前咨询。随着胎儿 MRI 使用的增加，有更大的动力去了解在子宫内诊断出的最常见的中枢神经系统结构异常，以及它们的自然历史。

作者对 2012 年 1 月至 2020 年 12 月期间进行的胎儿 MRI 评估进行了单中心回顾性审查。纳入了对 CNS 异常进行产前和产后神经外科评估的儿童。注意到胎儿 MRI 上的特定 CNS 异常、相关的 CNS 外发现以及对遗传异常或综合征的怀疑。评估了产后临床状况和干预措施。

2012 年 1 月至 2020 年 12 月期间，共进行了 469 次胎儿 MRI 评估；其中，114 对母胎有中枢神经系统异常，需要产前会诊和产后儿科神经外科随访。该队列包括 67 名男婴 (59%)，出生后平均 ± SD 随访时间为 29.8 ± 25.0 个月。在胎龄 27.3 ± 5.8 周时进行胎儿 MRI。最常见的 CNS 异常是脑室扩大 (57%)、胼胝体发育不全或变薄 (33%)、Dandy-Walker 复合体 (DWC) (21%)、神经元迁移障碍 (18%) 和隔膜异常透明 (17%)。21 名儿童 (18%) 需要神经外科干预，平均年龄为 2.4 ± 3.7 个月。最常见的手术病症包括脊髓脊膜膨出、中度至重度脑室扩大、脑膨出、和蛛网膜囊肿。胼胝体发育不全或变薄与发育迟缓（p = 0.02）和全身异常（p = 0.05）有关。大多数转诊接受 DWC 的产前患者都有不需要手术干预的 Dandy-Walker 变异。

产前神经外科评估最常见的疾病是脑室扩大、胼胝体异常和 DWC，而最常见的手术疾病是脊髓脊膜膨出、脑积水和蛛网膜囊肿。只有 18% 的产前神经外科会诊导致婴儿期进行手术干预。大多数产前轻度脑室扩大和 DWC 的转诊与发育或手术后遗症无关。胼胝体异常的患者应同时转诊给神经科医生进行发育评估。