{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:19:30Z","timestamp":1785860370113,"version":"3.56.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,7]]},"abstract":"\nOBJECTIVE<\/jats:title>\nBenign enlargement of the subarachnoid spaces (BESS) is a common finding on imaging studies indicated by macrocephaly in infancy. This finding has been associated with the presence of subdural fluid collections that are sometimes construed as suggestive of abusive head injury. The prevalence of BESS among infants with macrocephaly and the prevalence of subdural collections among infants with BESS are both poorly defined. The goal of this study was to determine the relative frequencies of BESS, hydrocephalus, and subdural collections in a large consecutive series of imaging studies performed for macrocephaly and to determine the prevalence of subdural fluid collections among patients with BESS.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nA text search of radiology requisitions identified studies performed for macrocephaly in patients \u2264 2 years of age. Studies of patients with hydrocephalus or acute trauma were excluded. Studies that demonstrated hydrocephalus or chronic subdural hematoma not previously recognized but responsible for macrocephaly were noted but not investigated further. The remaining studies were reviewed for the presence of incidental subdural collections and for measurement of the depth of the subarachnoid space. A 3-point scale was used to grade BESS: Grade 0, < 5 mm; Grade 1, 5\u20139 mm; and Grade 2, \u2265 10 mm.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nAfter exclusions, there were 538 studies, including 7 cases of hydrocephalus (1.3%) and 1 large, bilateral chronic subdural hematoma (0.2%). There were incidental subdural collections in 21 cases (3.9%). Two hundred sixty-five studies (49.2%) exhibited Grade 1 BESS, and 46 studies (8.6%) exhibited Grade 2 BESS. The prevalence of incidental subdural collections among studies with BESS was 18 of 311 (5.8%). The presence of BESS was associated with a greater prevalence of subdural collections, and higher grades of BESS were associated with increasing prevalence of subdural collections. After controlling for imaging modality, the odds ratio of the association of BESS with subdural collections was 3.68 (95% CI 1.12\u201312.1, p = 0.0115). There was no association of race, sex, or insurance status with subdural collections. Patients with BESS had larger head circumference Z-scores, but there was no association of head circumference or age with subdural collections. Interrater reliability in the diagnosis and grading of BESS was only fair.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nThe current study confirms the association of BESS with incidental subdural collections and suggests that greater depth of the subarachnoid space is associated with increased prevalence of such collections. These observations support the theory that infants with BESS have a predisposition to subdural collections on an anatomical basis. Incidental subdural collections in the setting of BESS are not necessarily indicative of abusive head injury.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.12.peds15600","type":"journal-article","created":{"date-parts":[[2016,3,4]],"date-time":"2016-03-04T14:58:52Z","timestamp":1457103532000},"page":"16-20","source":"Crossref","is-referenced-by-count":81,"title":["Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections"],"prefix":"10.3171","volume":"18","author":[{"given":"Jacqueline","family":"Tucker","sequence":"first","affiliation":[{"name":"Pennsylvania State University, State College;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arabinda Kumar","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Radiology and"},{"name":"Departments of Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Piatt","sequence":"additional","affiliation":[{"name":"Nemours Neuroscience Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware"},{"name":"Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds15600","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1177\/088307389901401010","article-title":"Magnetic resonance imaging characteristics of benign macrocephaly in children","volume":"14","author":"Alper","year":"1999"},{"key":"b2-peds15600","series-title":"Ann Pediatr (Paris)","first-page":"550","article-title":"[Idiopathic pericerebral swelling (external hydrocephalus) of infants.]","volume":"39","author":"Azais","year":"1992"},{"key":"b3-peds15600","series-title":"Arch Pediatr","first-page":"983","article-title":"[Idiopathic pericerebral enlargement in infants: simple anatomical variant or hemorrhagic risk factor?]","volume":"4","author":"Gout","year":"1997"},{"key":"b4-peds15600","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.3174\/ajnr.A3588","article-title":"Prevalence of subdural collections in children with macrocrania","volume":"34","author":"Greiner","year":"2013"},{"key":"b5-peds15600","series-title":"Eur J Pediatr","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1007\/BF01959405","article-title":"Primitive megalencephaly in children: Natural history, medium term prognosis with special reference to external hydrocephalus","volume":"149","author":"Laubscher","year":"1990"},{"key":"b6-peds15600","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1148\/radiology.184.3.1509061","article-title":"US measurement of the subarachnoid space in infants: normal values","volume":"184","author":"Libicher","year":"1992"},{"key":"b7-peds15600","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"438","DOI":"10.3171\/2012.12.PEDS12289","article-title":"Subdural hemorrhage in pediatric patients with enlargement of the subarachnoid spaces","volume":"11","author":"McKeag","year":"2013"},{"key":"b8-peds15600","series-title":"AJNR Am J Neuroradiol","first-page":"1725","article-title":"Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse","volume":"27","author":"McNeely","year":"2006"},{"key":"b9-peds15600","series-title":"AJNR Am J Neuroradiol","first-page":"564","article-title":"Children with macrocrania: clinical and imaging predictors of disorders requiring surgery","volume":"22","author":"Medina","year":"2001"},{"key":"b10-peds15600","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1007\/BF00306274","article-title":"Subarachnoid fluid collection in infants complicated by subdural hematoma","volume":"9","author":"Mori","year":"1993"},{"key":"b11-peds15600","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1159\/000055951","article-title":"A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma","volume":"33","author":"Papasian","year":"2000"},{"key":"b12-peds15600","series-title":"Int J Legal Med","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s00414-008-0242-6","article-title":"Influence of the benign enlargement of the subarachnoid space on the bridging veins strain during a shaking event: a finite element study","volume":"122","author":"Raul","year":"2008"},{"key":"b13-peds15600","series-title":"Pediatr Neurol","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/S0887-8994(02)00500-3","article-title":"External hydrocephalus: a probable cause for subdural hematoma in infancy","volume":"28","author":"Ravid","year":"2003"},{"key":"b14-peds15600","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1007\/s00381-010-1105-2","article-title":"Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature","volume":"26","author":"Vinchon","year":"2010"},{"key":"b15-peds15600","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"432","DOI":"10.3174\/ajnr.A3989","article-title":"Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications","volume":"36","author":"Wittschieber","year":"2015"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/1\/article-p16.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/1\/article-p16.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/1\/article-p16.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:12:56Z","timestamp":1681564376000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/1\/article-p16.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":15,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2015.12.peds15600","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7]]}}}