Management of subarachnoid fluid collection in infants based on a long-term follow-up study

Nishimura, K.; Mori, Koreaki; Sakamoto, Takashi; Fujiwara, K.

doi:10.1007/bf01411358

Cited by 33 publications

(28 citation statements)

References 37 publications

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“…Furthermore, other studies have demonstrated that the clinical evolution of some children with benign extracerebral fluid collection in infancy may not be so benign, as they present a higher risk of development of subdural hematomas after minor traumas. 24,28 In accordance with previous reports, 17 our findings suggest that there might be a small subgroup of children initially presenting with benign extracerebral fluid collections in infancy who might actually benefit from early intervention with shunt placement, especially those who present with subdural collections as complications, those with a more significant cognitive impairment, and those who present with some specific risk factors identified in the present study. Some of these factors that have been associated with an increased risk of development of arachnoid cysts, and that might help to select the subgroup of children who might benefit from a more aggressive interventional approach, are: 1) the presence of plagiocephaly, which increased the risk of development of arachnoid cysts by an odds ratio of 4.96 in comparison with children with benign extracerebral fluid collection and without plagiocephaly; and 2) extracerebral fluid collection restricted to the bilateral frontal region, which increased the risk of development of arachnoid cyst by an odds ratio of 5.73 in comparison with children with benign extracerebral collection that extended to multiple lobes (frontotemporal and frontoparietal regions).…”

supporting

confidence: 92%

Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts

Mattei¹,

Bond²,

Sambhara³

et al. 2013

PED

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Object Intracranial arachnoid cysts are a relatively common benign intracranial pathology, accounting for as many as 0.75%–1% of nontraumatic CNS lesions. Although it has already been demonstrated that rupture of arachnoid cysts may lead to subdural hematomas/hygromas, no study to date has investigated benign extracerebral collection in infancy as a possible predisposing factor for further development of arachnoid cysts. Methods The authors performed a retrospective imaging and chart review of macrocephalic infants 12 months old or younger who were referred to neurosurgical care at OSF St. Francis Medical Center from 2003 to 2010, and who were diagnosed with benign extracerebral fluid collection in infancy on thin-slice (1-mm) head CT scans. Special attention was given to the investigation of risk factors for further development of de novo arachnoid cysts. Several epidemiological factors in the infants and mothers were analyzed, including gestational age at delivery, mode of delivery, mother's age at delivery, delivery complications, birth weight, age of macrocephaly development, degree of macrocephaly, family history of macrocephaly, prenatal and postnatal history of infection, fontanel status, presence of papilledema, previous history of head trauma, and smoking status. Imaging characteristics of the initial scans, such as location of subdural collection (frontal vs frontoparietal and frontotemporal) and presence of ventriculomegaly, were also evaluated. For those patients in whom arachnoid cysts were identified on subsequent CT scans, the size and location of the cysts were also analyzed. Results The authors identified 44 children with benign extracerebral fluid collection in infancy. From this group, over a mean follow-up of 13 months (range 6–13 months), 18 children developed intracranial arachnoid cysts (a 40.9% incidence of de novo development of arachnoid cysts), with 27.8% presenting with bilateral cysts. In the multiple logistic regression analysis, infants who presented with an extracerebral collection restricted to the bilateral frontal region were more likely to develop intracranial arachnoid cysts (p = 0.035) than those with collections involving the frontotemporal and frontoparietal regions (odds ratio [OR] = 5.73). Additionally, children with benign extracerebral fluid collections and plagiocephaly were more likely to develop intracranial arachnoid cysts (p = 0.043) than those without plagiocephaly (OR = 4.96). Conclusions This is the first report in the neurosurgical literature demonstrating that benign extracerebral fluid collections in infancy may constitute a significant risk factor for development of de novo arachnoid cysts. These findings support a 2-hit hypothesis for the development of arachnoid cysts, in which the combination of an embryological defect in arachnoid development followed by a second event leading to impairment of CSF fluid absorption in early childhood could lead to abnormal CSF dynamics and the consequent expansion of fluid collections in the intraarachnoid spaces.

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supporting

confidence: 92%

Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts

Mattei¹,

Bond²,

Sambhara³

et al. 2013

PED

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Section: Introductionmentioning

confidence: 99%

“…The incidence of SDH in children with BEH is suspected to be much higher than that seen in the general population, as in one group of children with BEH where the incidence of SDH was 3/20 [1, 13]. Thus, children with BEH seem to be predisposed to developing acute SDH either spontaneously or following minor head trauma [1, 10, 11, 13]. The etiology of SDH in the setting of BEH is also poorly understood but presumably derives from anatomical and geometric stresses on blood vessels in the enlarged SAS/subdural space [12, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma

Papasian

Frim²

2000

Pediatr Neurosurg

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Introduction: There is controversy over whether there exists a predisposition towards bleeding into the subdural space in infants with benign external hydrocephalus (BEH) or other enlargement of the extra-axial space (e.g. subdural hygroma). The presumed etiology implicates shear forces in over-stretching the extra-axial blood vessels. We have created a model of the intracranial space that approximates certain aspects of BEH. Using this model, we predict situations where children with BEH will bleed into the extra-axial space when normal infants will not. Methods: The cranial model consists of two spheres representing the brain and the skull. The distance between them represents the width of the extra-axial space. The spheres are concentric (with interspheric distance equal to N) in the normal condition and nonconcentric in BEH. In BEH, the distance between the two spheres varies from N to Q (0 < N ≤ Q) over a 906 M ≤ Q, with the translation orthogonal to the vector of N and parallel to that of M or vice versa), then the final length V_f of a vein V is V_f = (N² + M)^1/2, and the stretch ratio V_f/V_i is: V_f/V_i = (N² + M²)^1/2/N·S_i, with S_i the slack factor, where i represents either n for normal or b for BEH and M = N in the normal condition. Results: Given an equivalent capacity of veins to resist stretch injury (based on the proportion of change in length), for brain translations after a low-impact head injury, stretch ratios for BEH veins range from 1.677 to 3.436, whereas in the normal condition they range from 1.061 to 1.179. Therefore, for an increase in subarachnoid space from 3 (normal) to 6 mm (BEH), brain translocation in BEH will stretch veins beyond an average breaking point when the translation for the normal condition will not. Conclusions: Mathematical modeling of the cranial vault produces a relationship between venous stretch and the width of the extra-axial space. These equations predict an increased frequency of venous stretch injury in the situation of widened extra-axial space. Such venous injury is consistent with forces generated by minor trauma. This relationship, as predicted by our model, could underlie a predisposition towards extra-axial bleeding after minor head trauma in infants with BEH.

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“…2,29,31) Acute or chronic subdural hematoma or hygroma are wellknown complications after extracranial shunting, and are considered to be overdrainage-related phenomena. 9,13,26,32,34,37,49) We report two cases of subdural hygroma which occurred in a series of 77 neuroendoscopic procedures and discuss the possible etiologies as well as the surgical and clinical consequences.…”

Section: Introductionmentioning

confidence: 99%

Subdural Hygroma as a Complication of Endoscopic Neurosurgery. Two Case Reports.

Freudenstein

Wagner

Ernemann

et al. 2002

Neurol. Med. Chir.(Tokyo)

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Two cases of subdural hygroma occurred in a series of 77 neuroendoscopic procedures. An 8-year-old boy underwent neuroendoscopic cysto-cisternostomy of a left temporal arachnoid cyst. Routine postoperative magnetic resonance imaging 7 days later showed a large left-sided subdural hygroma without clinical symptoms. During the following 3 months, the subdural hygroma did not resolve spontaneously, so it was drained through a burr hole. A 3-month-old boy with aqueductal stenosis developed bilateral subdural hygromas after third ventriculostomy. Several punctures through the open anterior fontanelle relieved the hygromas but increasing head circumference required ventriculoperitoneal shunting 12 months later. Complications of neuroendoscopic procedures are increasingly reported, including various kinds of bleeding, infections, or damage of neuronal tissue. Only three previous cases of subdural hygroma or hematoma after neuroendoscopic interventions have been reported. The possible etiologies and clinical consequences of this rare complication have to be considered before selecting neuroendoscopy treatment.

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Management of subarachnoid fluid collection in infants based on a long-term follow-up study

Cited by 33 publications

References 37 publications

Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts

Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts

A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma

Subdural Hygroma as a Complication of Endoscopic Neurosurgery. Two Case Reports.

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