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CH is a significant contributor to childhood morbidity and mortality and a driver of healthcare costs. In many cases, prenatal ultrasound can readily identify ventriculomegaly as early as 14\u201320\u00a0weeks of gestation, with severe cases showing poor neurodevelopmental outcomes. Postnatal surgical approaches, such as ventriculoperitoneal shunts, do not address the underlying genetic causes, have high complication rates, and result in a marginal improvement of neurocognitive deficits. Prenatal somatic cell gene therapy (PSCGT) promises a novel approach to conditions such as CH by targeting genetic mutations in utero, potentially improving long\u2010term outcomes. To better understand the pathophysiology, genetic basis, and molecular pathomechanisms of CH, we conducted a scoping review of the literature that identified over 160 published genes linked to CH. Mutations in <jats:italic>L1CAM<\/jats:italic>, <jats:italic>TRIM71<\/jats:italic>, <jats:italic>MPDZ<\/jats:italic>, and <jats:italic>CCDC88C<\/jats:italic> play a critical role in neural stem cell development, subventricular zone architecture, and the maintenance of the neural stem cell niche, driving the development of CH. Early prenatal interventions targeting these genes could curb the development of the expected CH phenotype, improve neurodevelopmental outcomes, and possibly limit the need for surgical approaches. However, further research is needed to establish robust genotype\u2010phenotype correlations and develop safe and effective PSCGT strategies for CH.<\/jats:p>","DOI":"10.1002\/pd.6654","type":"journal-article","created":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T02:09:20Z","timestamp":1725242960000},"page":"1354-1366","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Conundrum of Mechanics Versus Genetics in Congenital Hydrocephalus and Its Implications for Fetal Therapy Approaches: A Scoping Review"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2061-4099","authenticated-orcid":false,"given":"Akos","family":"Herzeg","sequence":"first","affiliation":[{"name":"Department of Surgery University of California, San Francisco  San Francisco California USA"},{"name":"UCSF Center for Maternal\u2010Fetal Precision Medicine University of California San Francisco  San Francisco 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