Seminars in Fetal & Neonatal Medicine 17 (2012) 251
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Seminars in Fetal & Neonatal Medicine
journal homepage: www.elsevier.com/locate/siny
Editorial
Fetal neurology: Volume I
One of the most exciting fields in advanced fetal and neonatal
medicine must be that of fetal neurology. For centuries, different
approaches have been performed in the various disciplines of neu-
roembryology, neurophysiology, neuroanatomy, pathophysiology
and neuroimaging. Pioneering efforts during the last 20 years
have improved remarkably. As expectant parental anxiety has
been increasing with regard to having a healthy baby with normal
neurological function, there is now great demand for accurate
prenatal central nervous system (CNS) diagnoses because the fetal
brain is key to each individual future life. Therefore, ethics is an
essential dimension of the management of pregnancies compli-
cated by a neurologic anomaly (Chapter 1).
More than 99% of the human neocortex is fashioned during
intrauterine life, resulting in the fascinating diversity of fetal func-
tions and activities. For understanding fetal and neonatal brain
structure and function, knowledge of neurophysiology is essential
(Chapter 2).
High-resolution three-dimensional (3D) ultrasound enables
visualization of small embryos and fetuses, and embryology
in vivo – 3D sonoembryology – has been established based on
conventional embryology (Chapter 3). Neurosonography by
advanced transvaginal sonography combined with 3D ultrasound
has revealed normal and abnormal intracranial morphology. Trans-
vaginal 3D sonography demonstrates bony structure, multiplanar
analysis of inside detailed morphology, tomographic ultrasound
imaging in all cutting sections, volume calculation of ventricles
and/or intracranial lesions as well as 3D sonoangiograms (Chapter
4). Advanced magnetic resonance imaging (MRI) is another useful
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http://dx.doi.org/10.1016/j.siny.2012.07.003
modality, adding morphological information to sonographic find-
ings, as well as metabolic information by magnetic resonance spec-
troscopy and functional assessment by dynamic steady-state free
precession and brain connectivity by diffusion tensor imaging
and tractography (Chapter 5). Sophisticated ultrasound imaging
and advanced MRI are collaborative and complementary imaging
modalities in fetal neurology.
Chapter 6 shows interesting pathophysiology of fetal hydro-
cephalus. Although CNS disorders, including ventriculomegaly,
congenital anomalies and intrauterine brain injuries have been
well demonstrated in detail by imaging modalities (Chapter 7),
the pathophysiology of congenital and neonatal hydrocephalus is
still not well understood. Finally, estimating the neurological
outcome and prognosis of ventriculomegaly diagnosed antenatally
and counseling parents are difficult tasks for clinicians. Chapter 8
describes management and prognosis of ventriculomegaly cases.
The articles here cover many aspects of fetal neurology but all of
the distinguished authors have the exactly same goal for ‘the fetus
as patient’. I sincerely hope that the publication will be of help to
current and future practitioners in this field.
Ritsuko K. Pooh*
CRIFM Clinical Research Institute of Fetal Medicine PMC, 7-3-7,
Uehommachi, Tennoji, Osaka 543-0001, Japan
* Tel.: þ81 6 6775 8111; fax: þ81 6 6775 8122.
E-mail address: evp-pooh@fetal-medicine-pooh.jp