Extra-axial cerebrospinal fluid spaces in children with benign external hydrocephalus: A case-control study

Hussain, Zaamin B.; Hussain, Amaani; Mitchell, Patrick

doi:10.1177/1971400917719298

Cited by 13 publications

(13 citation statements)

References 33 publications

(56 reference statements)

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“…The area under the ROC curve (AUC) was used to evaluate the diagnostic relevance of ON measurements in identifying patients with enlarged CSF space. For all subjects, Z-scores of the maximal frontal SAS and interhemispheric fissure widths were computed, to determine the deviation from measurements obtained in a large sample of healthy children ( n = 150, age <25 months) ( 7 ). We classified each subject's frontal SAS and interhemispheric fissure widths as increased (values exceeding 1.96SD) or within the normal range.…”

Section: Resultsmentioning

confidence: 99%

Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus

et al. 2021

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Background: Benign external hydrocephalus (BEH) is defined by rapid increase in head circumference in infancy, with neuroimaging evidence of enlarged cerebrospinal fluid (CSF) spaces. BEH was postulated to predispose to subdural hematoma, neurocognitive impairments, and autism. There is currently no consensus on BEH diagnostic criteria and no biomarkers to predict neurological sequalae.Methods: MRI-based quantitative approach was used for measurement of potential imaging markers related to external hydrocephalus and their association with neurological outcomes. We scanned 23 infants diagnosed with BEH and 11 age-similar controls. Using anatomical measurements from a large sample of healthy infants (n = 150), Z-scores were calculated to classify subject's CSF spaces as enlarged (≥1.96SD of mean values) or normal.Results: Subjects with abnormally enlarged CSF spaces had a significantly wider and longer ON (p = 0.017 and p = 0.020, respectively), and a significantly less tortuous ON (p = 0.006). ON deformity demonstrated a high diagnostic accuracy for abnormally enlarged frontal subarachnoid space (AUC = 0.826) and interhemispheric fissure (AUC = 0.833). No significant association found between enlarged CSF spaces and neurological complications (OR = 0.330, 95%CI 0.070–1.553, p = 0.161). However, cluster analysis identified a distinct subgroup of children (23/34, 67.6%) with enlarged CSF spaces and a wider, longer and less tortuous ON, to have an increased risk for neurological complications (RR = 7.28, 95%CI 1.07–49.40).Discussion: This is the first report on the association between external hydrocephalus, ON deformity and neurological complications. Our findings challenge the current view of external hydrocephalus as a benign condition. ON deformity is a potential auxiliary marker for risk stratification in patients with enlarged CSF spaces.

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Section: Resultsmentioning

confidence: 99%

Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus

et al. 2021

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“…In a study by Hussain et al . [21], involving assessment of the subarachnoid space around the frontal squama and the interhemispheric fissure of the brain with normative values creation, it was shown that the disease is not easy to diagnose. The space sizes measured directly in the MR images as well as presented as linear indices taking into account the dimensions of the skull, obtained in the group of healthy children and those diagnosed with BESS, may overlap to some extent.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of subarachnoid space and subarachnoid cisterns in children and teenagers based on computed tomography studies

Wilk¹,

Kluczewska²,

Likus³

2019

Pol J Radiol

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The aim of the study was to develop the normative values of linear indices to the diagnosis of changes in size of the subarachnoid space. Material and methods: Retrospective studies were conducted based on 507 head computed tomography (CT) exa minations in children from 018 years of age. In total 381 tests were selected for correct reference values. Patients were divided into age groups. For each group, linear indices were calculated, taking into account the size of the fluid spaces in relation to the size of the skull and then the mean with standard deviation, median, as well as 10 th and 90 th percentile were calculated. The range between the 10 th and the 90 th percentiles was defined as the reference value. Results: Obtained normative values, minimum and maximum for all groups: index of basal cistern size to the size of the skull-0.1290.197; index of basal cistern transverse dimension to the size of the skull-0.1730.255; index of basal cistern sagittal dimension to the size of the skull-0.0860.150; index of prepontine cistern-0.0340.067; index of interhemispheric fissure width-0.0440.127; index of Sylvian fissure-0.0360.085; index of insular cistern width-0.0200.074; index of subarachnoid space-0.0170.081. Conclusions: The linear indices can be calculated based on images achieved during routine CT examination. The ref erence values allow us to determine if the size of the subarachnoid space is within the normal range for a given age group. The results from the oldest age group can also be referred to the adults.

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“…If there was a question whether the ventriculomegally was due to ex-vacuo dilatation, an increase in the temporal horns of the ventricles was taken to suggest hydrocephalus [13]. In external hydrocephalus, the definition of an increased frontal subarachnoid space above 10 mm in thickness and head circumference above the 97th percentile or rapid crossing of centile lines was used [14]. Obstructed patients had no flow through the aqueduct on flow quantification.…”

Section: Subjectsmentioning

confidence: 99%

The incidence of significant venous sinus stenosis and cerebral hyperemia in childhood hydrocephalus: prognostic value with regards to differentiating active from compensated disease

Bateman

Yap

Subramanian

et al. 2020

Fluids Barriers CNS

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Background: Symptomatic or active hydrocephalus in children is linked to an elevation in intracranial pressure (ICP), which is likely to be multifactorial in origin. The CSF outflow resistance, venous sinus resistance and total cerebral blood flow are likely factors in the ICP elevation. The purpose of this paper is to define the incidence, site and significance of venous sinus stenosis and/or cerebral hyperemia in a cohort of children diagnosed with hydrocephalus at a tertiary referral hospital. Methods: The imaging database was reviewed over a 10 year period and the index MRI of all children between the ages of 4 months and 15 years, who were diagnosed with treatment naive hydrocephalus of any type (excluding secondary to tumor) and had magnetic resonance venography (MRV) and flow quantification were selected. Patients were compared with children undergoing an MRI with MRV and flow quantification who were subsequently shown to have no abnormality. The cross-sectional area and circumference of the sinuses were measured at 4 levels. The hydraulic and effective diameters were calculated. An area stenosis of 65% or greater was deemed significant. A total cerebral blood flow greater than two standard deviations above the mean for controls was taken to be abnormal. Results: There were a total of 55 children with hydrocephalus compared to 118 age matched control MRV's and 35 control flow quantification studies. A high grade stenosis occurred in 56% of patients but in none of the controls (p < 0.0001). The commonest site of narrowing was in the distal sigmoid sinus. Cerebral hyperemia occurred in 13% of patients but did not occur in the controls. Conclusions: The elevation in ICP in symptomatic hydrocephalus is multifactorial. Both high grade venous stenosis and cerebral hyperemia are common in childhood hydrocephalus. High grade stenosis was noted to be a risk factor for conservative management failure. Hyperemia was a good prognostic indicator.

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Extra-axial cerebrospinal fluid spaces in children with benign external hydrocephalus: A case-control study

Cited by 13 publications

References 33 publications

Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus

Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus

Evaluation of subarachnoid space and subarachnoid cisterns in children and teenagers based on computed tomography studies

The incidence of significant venous sinus stenosis and cerebral hyperemia in childhood hydrocephalus: prognostic value with regards to differentiating active from compensated disease

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