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Head Growth in Infants with Benign Enlargement of Subarachnoid Spaces Versus Macrocephaly
Sasidhar Karuparti1, Ashlynn Lizer2, Farrell Landwehr1
1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO; University of Missouri School of Medicine, Columbia, MO.
Insights
Infants with benign expansion of subarachnoid spaces (BESS) exhibit distinct head growth patterns compared to WHO standards and isolated macrocephaly cases. This research aids in identifying BESS in infants presenting with macrocephaly.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Growth and Development
Background:
- Macrocephaly, or large head size, can be associated with various conditions.
- Benign expansion of subarachnoid spaces (BESS) is a finding in some infants with macrocephaly.
- Understanding head growth trajectories is crucial for diagnosing and managing macrocephaly.
Purpose of the Study:
- To compare head growth in infants with BESS versus those with isolated macrocephaly.
- To evaluate head circumference growth against World Health Organization (WHO) standard curves.
- To identify potential indicators for BESS in macrocephalic infants.
Main Methods:
- Retrospective review of intracranial imaging in macrocephalic infants (2012-2022).
- Categorization into isolated macrocephaly or BESS groups.
- Nonlinear regression analysis of head circumference (HC) growth curves compared to WHO standards.
Main Results:
- Infants with BESS showed significantly larger head circumferences than WHO curves and isolated macrocephaly cohorts.
- Head circumference z-scores were higher in BESS infants (male: P = .0032, female: P < .001).
- A head circumference growth rate >0.043 cm/day between 5-7 months was 82% specific for BESS.
Conclusions:
- Head growth trajectories in infants with BESS differ from those with isolated macrocephaly and WHO standards.
- These findings may assist in identifying infants with BESS among those presenting with macrocephaly.
- Further research can refine diagnostic criteria for BESS.
Objective:
To examine head growth in macrocephalic infants with benign expansion of subarachnoid spaces (BESS) relative to those without imaging abnormalities and World Health Organization (WHO) standard curves.
Study Design:
Patients with macrocephaly who underwent intracranial imaging at St. Louis Children's Hospital between 2012 and 2022 were identified via radiology records search. Records were retrospectively reviewed to identify patients with isolated macrocephaly (without intracranial abnormalities) and BESS (defined by macrocephaly and concurrent imaging diagnosis of BESS by neuroradiology). Nonlinear least-squares regression of head circumference (HC) by cohort and gender was performed and compared with WHO curves.
Results:
Infants with macrocephaly and BESS (n = 159, 29% female) and macrocephaly without BESS (n = 152, 28% female) were included. Infants with BESS have larger HCs than the WHO 97th-percentile curve (male: P = .0032, female: P < .001) as well as infants with isolated macrocephaly (male: P = .0095, female: P < .001). Ventricle size (estimate: 1.751; 95% CI -0.728-4.230, P = .102), but not subarachnoid space (estimate: -0.057; 95% CI -0.697-0.583, P = .861), appeared to be positively associated with HC z-score, but was not significant. HC rate of change >0.043 cm/day at 5-7 months of age was 82% specific (95% CI 70.0-92.0) for BESS.
Conclusions:
Infants with BESS have different head growth trajectories compared infants with isolated macrocephaly as well as WHO curves. This study provides preliminary insights into head growth in BESS and may help identify patients more likely to have BESS among those presenting with macrocephaly.
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