Reduction cranioplasty for neglected hydrocephalus

Ventureyra, Enrique C. G.; Silva, Vasco F. Da

doi:10.1016/0090-3019(81)90153-1

Cited by 17 publications

(9 citation statements)

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“…We selected or developed a technique to address each patient's particular pathomorphology. If the blood loss is not excessive, reduction cranioplasty can be safely accomplished in one stage, as we did in one o f our cases and as reported by others [6,3], Because o f the risk o f large blood loss, we recommend that staging be considered in all cases. Proce dures can be staged in many ways, but we believe that it is most reasonable to make the scalp incision, strip the peri cranium, and accomplish most o f the osteotomies in the first stage.…”

Section: Discussionsupporting

confidence: 50%

“…In 1979, Vries and Habal [2] described a 5-staged procedure in which the supraorbi tal margins were repositioned in conjuction with a reduc tion cranioplasty; they used a midline (sagittal) strut of bone as the base upon which the remaining pieces o f the lateral convexity o f the skull were reattached, after having been reduced in size. In 1981, Ventureyra and D aSilva [3] reported using a similar technique in a 3-year-old boy via a bicoronal incision. In 1982, Ehni [4] published the treat ment 30 years earlier o f a patient with macrocephaly using specially designed gap-closing devices (designed by patient's father) in a series o f 13-staged procedures over 22 months.…”

Section: Introductionmentioning

confidence: 99%

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Reduction Cranioplasty

1995

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Reduction cranioplasty can greatly improve the quality of life for selected patients with severe macrocephaly and can significantly diminish some of the difficulties in the long-term chronic care of others. Because of differences in age, cranial morphology and surgical goals, the surgical plan must be tailored to the individual patient. Three techniques for reduction cranioplasty, with the advantages and disadvantages of each, are described. Four patients, representing the spectrum of severe macrocephaly and also the problems associated with reduction cranioplasty, are presented. Surgical indications, tactical considerations and risks are discussed.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Reduction Cranioplasty

1995

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“…Reduction cranioplasty is required in certain cases of hydrocephalic macrocephaly to decrease the size, weight, and contour of the significantly enlarged head. 3,6,15,16 In our study, 5 patients with an average age of 54 months (range 16-97 months) underwent reduction cranioplasty and all had improvement in motor function, including head control, sitting, and walking/standing. In addition, all parents were very satisfied and were uniformly pleased with the improvement in their child's appearance after surgery.…”

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%

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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“…[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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Reduction cranioplasty for neglected hydrocephalus

Cited by 17 publications

References 1 publication

Reduction Cranioplasty

Reduction Cranioplasty

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

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