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Benign Enlarged Subarachnoid Spaces
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Subarachnoid spaces (SAS)
                • Head circumference (HC)
                • Orbitofrontal circumference (OFC)
              • Synonyms

                • Benign enlargement of subarachnoid spaces of infancy (BESSI)
                • Benign external hydrocephalus
                • Benign extracerebral fluid collections of infancy
                • Benign communicating hydrocephalus
                • Physiologic extraventricular obstructive hydrocephalus
                • Benign macrocephaly of infancy
              • Definitions

                • Enlarged SAS in patient < 1 year of age with macrocrania (HC > 95%)

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Zahl SM et al: Clinical, radiological, and demographic details of benign external hydrocephalus: a population-based study. Pediatr Neurol. 96:53-7, 2019
                                            2. Zahl SM et al: Quality of life and physician-reported developmental, cognitive, and social problems in children with benign external hydrocephalus-long-term follow-up. Childs Nerv Syst. 35(2):245-50, 2019
                                            3. Hansen JB et al: Evaluations for abuse in young children with subdural hemorrhages: findings based on symptom severity and benign enlargement of the subarachnoid spaces. J Neurosurg Pediatr. 21(1):31-7, 2018
                                            4. Haws ME et al: A retrospective analysis of the utility of head computed tomography and/or magnetic resonance imaging in the management of benign macrocrania. J Pediatr. 182:283-9.e1, 2017
                                            5. Hussain ZB et al: Extra-axial cerebrospinal fluid spaces in children with benign external hydrocephalus: a case-control study. Neuroradiol J. 30(5):410-7, 2017
                                            6. Naffaa L et al: The diagnostic yield of ultrasound of the head in healthy infants presenting with the clinical diagnosis of benign macrocrania. Clin Radiol. 72(1):94.e7-94.e11, 2017
                                            7. Whitehead MT et al: Reduced subarachnoid fluid diffusion in enlarged subarachnoid spaces of infancy. Neuroradiol J. 30(5):418-24, 2017
                                            8. Tucker J et al: Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. J Neurosurg Pediatr. 1-5, 2016
                                            9. Halevy A et al: Development of infants with idiopathic external hydrocephalus. J Child Neurol. 30(8):1044-7, 2015
                                            10. Marino MA et al: Benign external hydrocephalus in infants. A single centre experience and literature review. Neuroradiol J. 27(2):245-50, 2014
                                            11. Greiner MV et al: Prevalence of subdural collections in children with macrocrania. AJNR Am J Neuroradiol. 34(12):2373-8, 2013
                                            12. Mattei TA et al: Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts. J Neurosurg Pediatr. 12(6):555-64, 2013
                                            13. Schulz M et al: Intracranial pressure measurement in infants presenting with progressive macrocephaly and enlarged subarachnoid spaces. Acta Neurochir Suppl. 114:261-6, 2012
                                            14. Sun M et al: Diffusion tensor imaging findings in young children with benign external hydrocephalus differ from the normal population. Childs Nerv Syst. 28(2):199-208, 2012
                                            15. Bateman GA et al: External hydrocephalus in infants: six cases with MR venogram and flow quantification correlation. Childs Nerv Syst. 27(12):2087-96, 2011
                                            16. Yew AY et al: Long-term health status in benign external hydrocephalus. Pediatr Neurosurg. 47(1):1-6, 2011
                                            17. Zahl SM et al: Benign external hydrocephalus: a review, with emphasis on management. Neurosurg Rev. 34(4):417-32, 2011
                                            18. Fernando S et al: Neuroimaging of nonaccidental head trauma: pitfalls and controversies. Pediatr Radiol. 38(8):827-38, 2008
                                            19. Hellbusch LC: Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up. J Neurosurg. 107(2 Suppl):119-25, 2007
                                            20. Paciorkowski AR et al: When is enlargement of the subarachnoid spaces not benign? A genetic perspective. Pediatr Neurol. 37(1):1-7, 2007
                                            21. Muenchberger H et al: Idiopathic macrocephaly in the infant: long-term neurological and neuropsychological outcome. Childs Nerv Syst. 22(10):1242-8, 2006
                                            22. Lam WW et al: Ultrasonographic measurement of subarachnoid space in normal infants and children. Pediatr Neurol. 25(5):380-4, 2001
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Subarachnoid spaces (SAS)
                                                          • Head circumference (HC)
                                                          • Orbitofrontal circumference (OFC)
                                                        • Synonyms

                                                          • Benign enlargement of subarachnoid spaces of infancy (BESSI)
                                                          • Benign external hydrocephalus
                                                          • Benign extracerebral fluid collections of infancy
                                                          • Benign communicating hydrocephalus
                                                          • Physiologic extraventricular obstructive hydrocephalus
                                                          • Benign macrocephaly of infancy
                                                        • Definitions

                                                          • Enlarged SAS in patient < 1 year of age with macrocrania (HC > 95%)

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Zahl SM et al: Clinical, radiological, and demographic details of benign external hydrocephalus: a population-based study. Pediatr Neurol. 96:53-7, 2019
                                                                                      2. Zahl SM et al: Quality of life and physician-reported developmental, cognitive, and social problems in children with benign external hydrocephalus-long-term follow-up. Childs Nerv Syst. 35(2):245-50, 2019
                                                                                      3. Hansen JB et al: Evaluations for abuse in young children with subdural hemorrhages: findings based on symptom severity and benign enlargement of the subarachnoid spaces. J Neurosurg Pediatr. 21(1):31-7, 2018
                                                                                      4. Haws ME et al: A retrospective analysis of the utility of head computed tomography and/or magnetic resonance imaging in the management of benign macrocrania. J Pediatr. 182:283-9.e1, 2017
                                                                                      5. Hussain ZB et al: Extra-axial cerebrospinal fluid spaces in children with benign external hydrocephalus: a case-control study. Neuroradiol J. 30(5):410-7, 2017
                                                                                      6. Naffaa L et al: The diagnostic yield of ultrasound of the head in healthy infants presenting with the clinical diagnosis of benign macrocrania. Clin Radiol. 72(1):94.e7-94.e11, 2017
                                                                                      7. Whitehead MT et al: Reduced subarachnoid fluid diffusion in enlarged subarachnoid spaces of infancy. Neuroradiol J. 30(5):418-24, 2017
                                                                                      8. Tucker J et al: Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. J Neurosurg Pediatr. 1-5, 2016
                                                                                      9. Halevy A et al: Development of infants with idiopathic external hydrocephalus. J Child Neurol. 30(8):1044-7, 2015
                                                                                      10. Marino MA et al: Benign external hydrocephalus in infants. A single centre experience and literature review. Neuroradiol J. 27(2):245-50, 2014
                                                                                      11. Greiner MV et al: Prevalence of subdural collections in children with macrocrania. AJNR Am J Neuroradiol. 34(12):2373-8, 2013
                                                                                      12. Mattei TA et al: Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts. J Neurosurg Pediatr. 12(6):555-64, 2013
                                                                                      13. Schulz M et al: Intracranial pressure measurement in infants presenting with progressive macrocephaly and enlarged subarachnoid spaces. Acta Neurochir Suppl. 114:261-6, 2012
                                                                                      14. Sun M et al: Diffusion tensor imaging findings in young children with benign external hydrocephalus differ from the normal population. Childs Nerv Syst. 28(2):199-208, 2012
                                                                                      15. Bateman GA et al: External hydrocephalus in infants: six cases with MR venogram and flow quantification correlation. Childs Nerv Syst. 27(12):2087-96, 2011
                                                                                      16. Yew AY et al: Long-term health status in benign external hydrocephalus. Pediatr Neurosurg. 47(1):1-6, 2011
                                                                                      17. Zahl SM et al: Benign external hydrocephalus: a review, with emphasis on management. Neurosurg Rev. 34(4):417-32, 2011
                                                                                      18. Fernando S et al: Neuroimaging of nonaccidental head trauma: pitfalls and controversies. Pediatr Radiol. 38(8):827-38, 2008
                                                                                      19. Hellbusch LC: Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up. J Neurosurg. 107(2 Suppl):119-25, 2007
                                                                                      20. Paciorkowski AR et al: When is enlargement of the subarachnoid spaces not benign? A genetic perspective. Pediatr Neurol. 37(1):1-7, 2007
                                                                                      21. Muenchberger H et al: Idiopathic macrocephaly in the infant: long-term neurological and neuropsychological outcome. Childs Nerv Syst. 22(10):1242-8, 2006
                                                                                      22. Lam WW et al: Ultrasonographic measurement of subarachnoid space in normal infants and children. Pediatr Neurol. 25(5):380-4, 2001