Follow-up study of macrocephalic children with enlargement of the subarachnoid space

Abstract

Eighteen macrocephalic children with enlargement of the subarachnoid space (ESAS), with or without mild ventricular dilatation, were followed prospectively to a mean age of 56 months. All were born at term, with uneventful neonatal period and negative tests for congenital infections. There were 17 boys and 1 girl and the mean follow-up period was 46 months (8-58 months). The initial neurologic evaluation, between ages of 2 to 33 months, disclosed abnormalities in 2 cases. At the follow-up one was still abnormal and the other had a normal neurological examination. Another child, who had a normal neurological examination at the age of 5 months, at the age of 7 years and 7 months had an IQ of 77. Thus the abnormality rate at follow-up was 11%. The OFC returned to the normal range in 45% of the children at the follow-up period. There were no cases of intracranial hypertension. One infant had subdural taps performed at the age of 13 months that disclosed a fluid with the same characteristics as the CSF. All the children had a CT-scan performed at the beginning of the study that revealed a large subarachnoid space; in 77% it was associated with mild ventricular dilatation. Eleven had CT-scans repeated, during the study period, which showed resolution of the process in 3 cases, improvement in 2, and unchanged in 6. We conclude that enlargement of the subarachnoid space in macrocephalic children is often a benign entity. ESAS and macrocephaly will still be present in the majority of children in the long-term follow-up.

Benign external hydrocephalus: a review, with emphasis on management

“…Measurements afterwards typically lie above but parallel to the upper (95th to 98th) percentile [2, 6, 14, 22, 115, 121, 147]. The amount of children ending up with macrocephaly varies considerably from 11% to 87% on long-term follow-up [3, 34, 60, 118].

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“…We have found a total of 37 articles that report outcome after some time [3, 4, 6, 13, 14, 22, 32, 33, 40, 42, 60, 74, 75, 78, 85, 87, 91, 95, 115, 116, 118, 121–124, 128, 132, 142–144, 147, 152, 153, 156, 159, 165, 167]. Scientific strength however is low; only one article [95] was considered as level 3 (Levels of Evidence, http://www.cebm.net/).…”

“…The studies report in general normal physical and neurological findings. Some conclude that all children are normal on last follow-up [6, 14, 22, 32, 33, 40, 42, 74, 85, 91, 115, 142, 144, 152, 156, 159, 165], while the remaining articles describe developmental delay among some of their patients [3, 4, 13, 60, 75, 78, 87, 95, 116, 118, 121–124, 128, 132, 143, 147, 153, 167]. …”

“…Several studies have followed children with external hydrocephalus for 2–5 years [13, 14, 34, 60, 78, 87, 122, 123, 147, 152]. About 17% of the 196 children included in these publications were described as having an abnormal psychomotor development at last follow-up.…”

“…Among the surveys reporting the size of the ventricular system, from none to all patients with external hydrocephalus showed some degree of ventricular dilatation [3, 6, 14, 33, 34, 60, 91, 95, 110, 114, 118, 139, 142]. These reports, however, do not give exact measurements.…”