Subdural hematoma prevalence and long-term developmental outcomes in patients with benign expansion of the subarachnoid spaces

View More View Less
  • 1 Department of Neurosurgery,
  • | 2 School of Medicine, and
  • | 3 Department of Radiology, University of Michigan, Ann Arbor, Michigan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Benign expansion of the subarachnoid spaces (BESS) is a condition seen in macrocephalic infants. BESS is associated with mild developmental delays which tend to resolve within a few years. It is accepted that patients with BESS are at increased risk of spontaneous subdural hematomas (SDHs), although the exact pathophysiology is not well understood. The prevalence of spontaneous SDH in BESS patients is poorly defined, with only a few large single-center series published. In this study the authors aimed to better define BESS prevalence and developmental outcomes through the longitudinal review of a large cohort of BESS patients.

METHODS

A large retrospective review was performed at a single institution from 1995 to 2020 for patients 2 years of age or younger with a diagnosis of BESS by neurology or neurosurgery and head circumference > 85th percentile. Demographic data, head circumference, presence of developmental delay, occurrence of SDH, and need for surgery were extracted from patient charts. The subarachnoid space (SAS) size was measured from the available MR images, and the sizes of those who did and did not develop SDH were compared.

RESULTS

Free text search revealed BESS mentioned within the medical records of 1410 of 2.6 million patients. After exclusion criteria, 480 patients remained eligible for the study. Thirty-two percent (n = 154) of patients were diagnosed with developmental delay, most commonly gross motor delay (53%). Gross motor delay resolved in 86% of patients at a mean age of 22.2 months. The prevalence of spontaneous SDH in this BESS population over a period of 25 years was 8.1%. There was no significant association between SAS size and SDH formation.

CONCLUSIONS

This study represents results for one of the largest cohorts of patients with BESS at a single institution. Gross motor delay was the most common developmental delay diagnosed, and a majority of patients had resolution of their delay. These data support that children with BESS have a higher prevalence of SDH than the general pediatric population, although SAS size was not significantly associated with SDH development.

ABBREVIATIONS

ASD = autism spectrum disorder; BEH = benign external hydrocephalus; BESS = benign expansion of the subarachnoid spaces; NAT = nonaccidental trauma; SAS = subarachnoid space; SDH = subdural hematoma.

Diagram from Behbahani et al. (pp 488–496).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Wiig US, Zahl SM, Egge A, Helseth E, Wester K. Epidemiology of benign external hydrocephalus in Norway—a population-based study. Pediatr Neurol. 2017;73:3641.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Zahl SM, Egge A, Helseth E, Wester K. Clinical, radiological, and demographic details of benign external hydrocephalus: a population-based study. Pediatr Neurol. 2019;96:5357.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Hussain ZB, Hussain AB, Mitchell P. Extra-axial cerebrospinal fluid spaces in children with benign external hydrocephalus: a case-control study. Neuroradiol J. 2017;30(5):410417.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Marino MA, Morabito R, Vinci S, et al. Benign external hydrocephalus in infants. A single centre experience and literature review. Neuroradiol J. 2014;27(2):245250.

  • 5

    Zahl SM, Egge A, Helseth E, Wester K. Benign external hydrocephalus: a review, with emphasis on management. Neurosurg Rev. 2011;34(4):417432.

  • 6

    Ghosh PS, Ghosh D. Subdural hematoma in infants without accidental or nonaccidental injury: benign external hydrocephalus, a risk factor. Clin Pediatr (Phila). 2011;50(10):897903.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Williams CA, Dagli A, Battaglia A. Genetic disorders associated with macrocephaly. Am J Med Genet A. 2008;146A(15):20232037.

  • 8

    Haws ME, Linscott L, Thomas C, Orscheln E, Radhakrishnan R, Kline-Fath B. A retrospective analysis of the utility of head computed tomography and/or magnetic resonance imaging in the management of benign macrocrania. J Pediatr. 2017;182:283289.e1.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Yew AY, Maher CO, Muraszko KM, Garton HJ. Long-term health status in benign external hydrocephalus. Pediatr Neurosurg. 2011;47(1):16.

  • 10

    Mikkelsen R, Rødevand LN, Wiig US, et al. Neurocognitive and psychosocial function in children with benign external hydrocephalus (BEH)-a long-term follow-up study. Childs Nerv Syst. 2017;33(1):9199.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Zahl SM, Egge A, Helseth E, Skarbø AB, Wester K. Quality of life and physician-reported developmental, cognitive, and social problems in children with benign external hydrocephalus-long-term follow-up. Childs Nerv Syst. 2019;35(2):245250.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Papasian NC, Frim DM. A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg. 2000;33(4):188193.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Högberg U, Andersson J, Squier W, et al. Epidemiology of subdural haemorrhage during infancy: a population-based register study. PLoS One. 2018;13(10):e0206340.

  • 14

    Jayawant S, Rawlinson A, Gibbon F, et al. Subdural haemorrhages in infants: population based study. BMJ. 1998;317(7172):15581561.

  • 15

    Hobbs C, Childs AM, Wynne J, Livingston J, Seal A. Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child. 2005;90(9):952955.

  • 16

    Tucker J, Choudhary AK, Piatt J. Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. J Neurosurg Pediatr. 2016;18(1):1620.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Hanauer DA, Mei Q, Law J, Khanna R, Zheng K. Supporting information retrieval from electronic health records: a report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE). J Biomed Inform. 2015;55:290300.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Neveling EA, Truex RC Jr. External obstructive hydrocephalus: a study of clinical and developmental aspects in ten children. J Neurosurg Nurs. 1983;15(4):255260.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Maenner MJ, Shaw KA, Baio J, et al. Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016. MMWR Surveill Summ. 2020;69(4)(SS-4):112.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Shen MD, Nordahl CW, Li DD, et al. Extra-axial cerebrospinal fluid in high-risk and normal-risk children with autism aged 2-4 years: a case-control study. Lancet Psychiatry. 2018;5(11):895904.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    McNeely PD, Atkinson JD, Saigal G, O’Gorman AM, Farmer JP. Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR Am J Neuroradiol. 2006;27(8):17251728.

    • Search Google Scholar
    • Export Citation
  • 22

    Hansen JB, Frazier T, Moffatt M, Zinkus T, Anderst JD. Evaluations for abuse in young children with subdural hemorrhages: findings based on symptom severity and benign enlargement of the subarachnoid spaces. J Neurosurg Pediatr. 2018;21(1):3137.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Fingarson AK, Ryan ME, McLone SG, Bregman C, Flaherty EG. Enlarged subarachnoid spaces and intracranial hemorrhage in children with accidental head trauma. J Neurosurg Pediatr. 2017;19(2):254258.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 401 401 70
Full Text Views 107 107 12
PDF Downloads 176 176 17
EPUB Downloads 0 0 0