Head Growth in Infants with Benign Expansion of Subarachnoid Spaces versus Macrocephaly.

Objective: To examine head growth in macrocephalic infants with benign expansion of subarachnoid spaces (BESS) relative to those without imaging abnormalities and WHO standard curves.

Study design: Patients with macrocephaly who underwent intracranial imaging at St. Louis Children's Hospital between 2012-2022 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 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 97^th-percentile curve (male: P=0.0032, female: P<0.001) as well as infants with isolated macrocephaly (male: P=0.0095, female: P<0.001). Ventricle size (estimate: 1.751; 95% CI -0.728-4.230, P=0.102), but not subarachnoid space (estimate: -0.057; 95% CI -0.697-0.583, P=0.861), 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.