Normal growth curve of choroid plexus in children: Implications for assessing hydrocephalus due to choroid plexus hyperplasia

Abstract

Structured AbstractObjectivePediatric hydrocephalus requires evaluation while accounting for growth of intracranial structures, but information on choroid plexus growth in children is lacking. This study aimed to create normal growth curves for intracranial volume, choroid plexus volume, and lateral ventricles volume and assess objectively the degree of hydrocephalus due to choroid plexus hyperplasia (CPH) and the effect of surgeries.MethodsThis retrospective study analyzed head computed tomography (CT) scans of pediatric patients with head trauma from Osaka Women’s and Children’s Hospital between April 2006 and April 2023. The study segmented the intracranial volume, choroid plexus, and lateral ventricles and calculated their volumes. The study also calculated correlation coefficients among the three parameters. Patients aged 0 to 10 years were divided into 15 age-related clusters and mean and standard deviation (SD) values were measured in each cluster. Growth curves were created by plotting mean values sequentially. Volume obtained from patients with CPH were z-normalized using mean and SD values and compared.ResultsA total of 222 CT scans (91 from females) were analyzed, and positive correlations were observed among intracranial volume, choroid plexus volume, and lateral ventricles volume, with the strongest correlation between choroid plexus and lateral ventricles volumes. The growth rate of intracranial volume was rapid until approximately 20 months of ages, while those of choroid plexus and lateral ventricles volume increased rapidly by approximately one year of age.After that, the volume reached plateau at 1.5 mL and 10mL in choroid plexus and lateral ventricles volume, respectively. Three patients with CPH were enrolled and quantitatively evaluated by the z-normalized volume (z.v.). Notable abnormal volume of choroid plexus (ranged z.v. 26.00 – 45.85) and lateral ventricles (ranged z.v.40.93 – 123.56) were observed. In two patients, z.v. lateral ventricles volumes improved after surgical interventions. Choroid plexus volume reduced by approximately 20% (from z.v. 45.85 to z.v. 36.95) after bilateral endoscopic plexus coagulation in one patient.ConclusionsThis study provides normal growth curves for intracranial volume, choroid plexus volume, and lateral ventricles volume. Knowledge of normal values enables objective assessment of abnormal values related to hydrocephalus and choroid plexus disease such as CPH.