Award: AAP/SONS Award

Authors: Mallory Peterson; Steven Schiff, MD, PhD; Vishal Monga; Venkateswararao Cherukuri (Hershey, PA)

Introduction:

Pediatric Neurosurgery is permeated by conditions and syndromes that lead to impairment in brain growth. Surgical management for such conditions might be better optimized by evaluating brain growth in comparison to normal growth.  Currently, however, no definitive brain growth curves exist to guide such care.

Methods:

Brain volume quantification was accomplished through the use of computational analyses of MRI scans of approximately 1500 normal healthy subjects from the age of 8 days to 22 years using the NIH Pediatric MRI Data Repository.  The toolboxes used for this analysis consisted of the Computational Anatomy Toolbox (CAT) within the Statistical Parametric Mapping (SPM) software system as well as the FSL segmentation pipeline.  The Developing Human Connectome Project (dHCP) pipeline designed by Makropoulos et al. (2018) was used to evaluate the neonatal scans.  The resulting volumes were fit with a family of nonlinear functions in order to provide smoothed curves for clinical use and research reference.  

Results:

Normal brain volume growth curves were developed for males and females, with smooth fits to generate means and standard deviations, resembling the Roche head circumference growth curves that are used to evaluate head size in hydrocephalus.  Furthermore, normal growth was plotted for left and right hemispheres as well as temporal lobes in order to contribute to the surgical management of epilepsy.  Finally, white matter, grey matter, and CSF volumes were calculated. We uncovered several previously unknown relationships, including a linear relationship between grey and white matter growth, as well as a nonlinear relationship between CSF accumulation and tissue growth.  These findings provide deeper insight into the compartments and components of the growing brain.  

Conclusion:

We have made substantial progress towards a canonical set of brain growth curves for use in Pediatric Neurosurgery for the more optimal management of hydrocephalus and other surgical disorders of children.