Bitonti Talia Mia, Chahrour Mohamad, Chee Sharini Sam, Burhunduli Patricia, Tu Albert
The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Division of Neurosurgery, Department of Surgery, CHEO, University of Ottawa, Ottawa, ON, Canada.
J Pediatr Clin Pract. 2025 Jun 13;17:200157. doi: 10.1016/j.jpedcp.2025.200157. eCollection 2025 Sep.
This study aimed to develop head circumference (HC) growth charts specific to infants and young children diagnosed with benign enlargement of the subarachnoid spaces. By modeling HC trajectories, we sought to establish normative curves that distinguish benign macrocephaly from pathologic causes of head enlargement. Our objective was to support accurate monitoring, reduce unnecessary imaging, and guide appropriate referral decisions in pediatric patients with macrocephaly.
A retrospective analysis of HC measurements was conducted using data from 137 patients aged 0-6 years diagnosed with benign macrocephaly at the Children's Hospital of Eastern Ontario. Generalized Additive Models for Location, Scale, and Shape were employed to create growth charts.
The study included 137 children with neuroimaging confirming benign macrocephaly diagnoses. Exclusion criteria were applied to ensure the cohort was representative of isolated benign macrocephaly cases. Benign macrocephalic percentile charts for HC were generated, showing accelerated early growth followed by stabilization around ages 2-3. For both boys and girls, the 50th centile tracks consistently above the 97th in World Health Organization data for non-benign macrocephalic patients. The majority of benign macrocephalic patients fell above the 97.5th percentile of the World Health Organization reference curves. We identified pathological growth by examining HCs greater than 60 cm and assessing for rapidly progressive HC growth patterns that required surgical intervention.
We provide novel benign macrocephaly growth charts that enable accurate monitoring of HC in clinical settings. Furthermore, the use of these curves may help differentiate patients with benign macrocephaly from other entities that may warrant surgical intervention such as hydrocephalus. Future research should validate these findings in multicenter prospective studies for practitioners to remain abreast in clinical management strategies for infants with benign macrocephaly.
本研究旨在制定针对被诊断为蛛网膜下腔良性扩大的婴幼儿的头围（HC）生长图表。通过对头围轨迹进行建模，我们试图建立规范曲线，以区分良性巨头畸形与头部增大的病理性原因。我们的目标是支持在患有巨头畸形的儿科患者中进行准确监测、减少不必要的影像学检查，并指导适当的转诊决策。
使用来自安大略东部儿童医院137例年龄在0至6岁、被诊断为良性巨头畸形患者的数据，对HC测量值进行回顾性分析。采用位置、尺度和形状的广义相加模型来创建生长图表。
该研究纳入了137例经神经影像学检查确诊为良性巨头畸形的儿童。应用排除标准以确保该队列代表孤立性良性巨头畸形病例。生成了HC的良性巨头畸形百分位图，显示早期生长加速，随后在2至3岁左右趋于稳定。对于男孩和女孩，在世界卫生组织非良性巨头畸形患者的数据中，第50百分位始终高于第97百分位。大多数良性巨头畸形患者的头围高于世界卫生组织参考曲线的第97.5百分位。我们通过检查头围大于60厘米并评估需要手术干预的快速进展性头围生长模式来识别病理性生长。
我们提供了新颖的良性巨头畸形生长图表，可在临床环境中对头围进行准确监测。此外，使用这些曲线可能有助于将良性巨头畸形患者与其他可能需要手术干预的疾病（如脑积水）区分开来。未来的研究应在多中心前瞻性研究中验证这些发现，以便从业者能够跟上良性巨头畸形婴儿临床管理策略的最新进展。
