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TO THE EDITOR: We are writing in reference to the study reported by Tucker et al.6 (Tucker J, Choudhary AK, Piatt J: Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. J Neurosurg Pediatr 18:16–20, July 2016). The goal of this study was to determine the relative frequencies of benign enlargement of the subarachnoid spaces (BESS) and subdural collections in a large consecutive series of imaging studies performed for macrocephaly, and to determine the prevalence of subdural fluid collections among patients with BESS. The authors reported that the presence of BESS was associated with a greater prevalence of subdural collections, and that higher grades of BESS were associated with increasing prevalence of subdural collections. They concluded that these results support the theory that infants with BESS have a predisposition to subdural collections on an anatomical basis. We would like to bring up several concerns regarding their conclusion. First, no clinical data concerning the 18 children with subdural collections are provided. Although the diagnosis of BESS is based on the expansion of the subarachnoid spaces, it is also dependent on necessary, important clinical data, as follows.

Letter to the Editor. Subdural collections in infants: trauma or not trauma?