A New Method for the Treatment of Macrocephaly Caused by Hydrocephalus

Mansour, Natalie; Sobel, Lisa; Lee, Mi-Sook; Larumbe, Jose; Stelnicki, Eric J.

doi:10.1597/03-091.1

Cited by 14 publications

(7 citation statements)

References 2 publications

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“…rocephaly due to hydrocephalus and that improvement of patient functioning and aesthetics could be achieved after surgery. 6,7,10,13,17 We reasoned that a simulated computer program to reconstruct the head prior to surgery should be used and, together with the aforementioned surgical techniques, could provide good aesthetic outcomes postoperatively. We also used a sagittal bandeau as described by Sundine et al 13 in all of our total cranial vault remodeling procedures for the correction of hydrocephalic macrocephaly (Figs.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the technical details and outcomes of using surgical methods for the treatment of hydrocephalic macrocephaly remain the focus of intensive discussions. 3,4,6,7,11,15,16,18 In this study, the clinical profile and outcome of the children with hydrocephalic macrocephaly who had undergone shunt surgeries with 1-stage total cranial vault remodeling were analyzed retrospectively. In addition, the feasibility of surgery for total cranial vault remodeling in children with hydrocephalic macrocephaly is discussed.…”

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confidence: 99%

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Reduction cranioplasty with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly

Shen

Kwan

Wang

et al. 2014

PED

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Object The occurrence of hydrocephalic macrocephaly is uncommon. When the condition does occur, it is usually seen in infants and young children. Patients with this disorder have an excessively enlarged head and weak physical conditions. Various surgical techniques of reduction cranioplasty for the treatment of these patients have been reported. In this study, a revised surgical procedure with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly is presented. Methods Five cases of hydrocephalic macrocephaly in children ranging in age from 16 to 97 months were reviewed. These patients underwent surgical treatment at The First Affiliated Hospital of Xiamen University over a period of 4 years from January 2007 to January 2011. After physical examination, a 3D computer imaging system to simulate the patient's postoperative head appearance and bone reconstruction was established. Afterward, for each case an appropriate surgical plan was designed to select the best remodeling method and cranial shape. Then, prior to performing reduction remodeling surgery in the patient according to the computer-simulated procedures, the surgeon practiced the bone reconstruction technique on a plaster head model made in proportion to the patient's head. In addition, a sagittal bandeau was used to achieve stability and bilateral symmetry of the remodeled cranial vault. Each patient underwent follow-up for 6–32 months. Results Medium-pressure ventriculoperitoneal shunt surgery or shunt revision procedures were performed in each patient for treating hydrocephalus, and all patients underwent total cranial vault remodeling to reduce the cranial cavity space. Three of the 5 patients underwent a single-stage surgery, while the other 2 patients underwent total cranial vault remodeling in the first stage and the ventriculoperitoneal shunt operation 2 weeks later because of unrecovered hydrocephalus. All patients had good outcome with regard to hydrocephalus and macrocephaly. Conclusions There are still no standard surgical strategies for the treatment of hydrocephalic macrocephaly. Based on their experience, the authors suggest using a computer imaging system to simulate a patient's postoperative head appearance and bone reconstruction together with total cranial vault remodeling with shunt surgery in a single-stage or 2-stage procedure for the successful treatment of hydrocephalic macrocephaly.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Reduction cranioplasty with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly

Shen

Kwan

Wang

et al. 2014

PED

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“…Many authors report placement of VP shunts or subcutaneous ventri cle-tapping reservoirs prior to definitive macrocephaly treatment. 4,6,7 We advocate the use of a CSF shunt with a programmable valve in this setting. This allows for con tinued management of the hydrocephalus and manage ment of postoperative subdural hematoma formation in this highrisk group.…”

Section: History Of Cranial Reduction Surgery For Macrocephaly Relatementioning

confidence: 99%

“…[2][3][4][7][8][9] Previous reports describe large holocalvarial reconstructions with substantial risk of hemorrhage, transfusion, prolonged time on the operating table, and multiple stages. Our technique limits the en tire process of reduction cranioplasty/fixation to 2 steps: placement of a CSF shunt, followed by a single cranial remodeling and fixation procedure that takes less than 1 hour.…”

Section: Early Cranial Fixation In Extreme Hydrocephalusmentioning

confidence: 99%

Cranial reduction and fixation with a resorbable plate combined with cerebrospinal fluid shunting for difficult-to-manage macrocephaly related to hydrocephalus

Manwaring

Truong

Deukmedjian

et al. 2013

PED

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The management of newborns with extreme macrocephaly related to hydrocephalus can be difficult; balancing the treatment of severe cranial deformity with optimal hydrocephalus management can be complicated. Excessive CSF drainage can result in significant suture overlap that leads to difficulties in patient positioning, secondary synostosis, and long-term aesthetic complications. Delayed cranial reduction and remodeling procedures carry significant risk, and the aesthetic outcomes have sometimes been poor. The authors describe a newborn with severe macrocephaly who underwent shunt placement followed by a limited cranial reduction and fixation procedure using an absorbable plate within the 1st week of life. The procedure produced an immediate intracranial volume reduction of 49%. This novel management strategy facilitated patient positioning, simplified hydrocephalus management, and provided an excellent aesthetic outcome.

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“…Newer reported techniques include limited reduction cranioplasty focused on correcting posterior turricephaly, 7 single-stage total cranial vault remodeling with the addition of prolonged helmet therapy, 8 and use of resorbable plating systems to aid in reconstruction. 9,10 Distraction osteogenesis (DO) was first utilized in craniofacial surgery as a technique for mandibular lengthening and later expanded upon as a technique for midface advancement and cranial vault remodeling. 11 In the cranial vault, DO is often used for posterior vault remodeling in the treatment of craniosynostosis, as the gradual expansion minimizes dead space and allows for concomitant expansion of the dura and soft tissues.…”

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Reverse Distraction Cranioplasty for Treatment of Hydrocephalic Megalocephaly

Saad

Kanack

McIntyre

et al. 2015

Journal of Craniofacial Surgery

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Macrocephaly resulting from untreated hydrocephalus is a rare but difficult condition to treat. The patient presented is a 6-year-old boy who had progressively increasing head size since birth secondary to untreated hydrocephalus with associated developmental delay. His initial head circumference was 69 cm, and computed tomography scan showed evidence of obstructive hydrocephalus. For the first stage of the procedure, bicoronal and circumferential strip craniectomies were performed, 5 fully open 3.5 mm midface distractors were placed to facilitate vault reduction, and absorbable plates were placed in the frontoorbital region. Neurosurgery also performed an endoscopic third ventriculostomy and placed an external ventricular drain. Reverse distraction was completed over 5 days and tolerated well by the patient. Three months after the first procedure, the distractors were removed and frontoorbital reduction and additional cranial vault reduction and reshaping were performed. At 1 month following this operation he was noted to have excellent forehead contour and dramatic improvement of his macrocephaly with some remaining mid-vault asymmetry. His head circumference was measured at 61.5 cm with bicoronal distance of 39.5 cm. He demonstrated improvement in head control and ability to sit. This patient demonstrates a new technique for reduction cranioplasty involving the use of reverse distraction to facilitate gradual and controlled reduction prior to extensive cranial vault remodeling. The challenges associated with managing hydrocephalus in cranial vault reduction patients are also addressed.

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A New Method for the Treatment of Macrocephaly Caused by Hydrocephalus

Abstract: The combination of these modalities represents a unique state-of-the-art method for the correction of severe macrocephaly without the risks of intracranial hemorrhage and provides a useful adjunct to the treatment of hydrocephalus.

Cited by 14 publications

References 2 publications

Reduction cranioplasty with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly

Reduction cranioplasty with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly

Cranial reduction and fixation with a resorbable plate combined with cerebrospinal fluid shunting for difficult-to-manage macrocephaly related to hydrocephalus

Reverse Distraction Cranioplasty for Treatment of Hydrocephalic Megalocephaly

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