Reverse Distraction for Treatment of Hydrocephalic Macrocephaly in Late Childhood.

Document Type

Article

Publication Date

3-2019

Identifier

DOI: 10.1097/SCS.0000000000005072

Abstract

Macrocephaly diminishes quality of life for children whose head size inhibits independent mobility and appropriate interaction with caregivers. Cranial reduction is a method of addressing these issues, historically with a high morbidity due most commonly to bleeding and shunt complications. The authors present a 9-year-old girl with holoprosencephaly and severe macrocephaly from progressive hydrocephalus who underwent cranial reduction via reverse distraction osteogenesis, a method to slowly reduce the skull volume. The patient underwent circumferential occipital temporoparietal frontal craniotomy with placement of 4 cranial distractors, followed approximately 1 month later by removal of the distractors and cranioplasty with resorbable fixation devices. The patient demonstrated significant postoperative improvement in head control and interaction in school activities. This is the oldest patient with macrocephaly treated with reverse distraction in the literature to date. The slow contraction of the cranial vault with limited bony surgery at the time of initial reduction provides an additional safety margin, and should be considered in older children presenting with profound macrocephaly.

Journal Title

The Journal of craniofacial surgery

Volume

30

Issue

2

First Page

532

Last Page

534

MeSH Keywords

Child; Craniotomy; Female; Holoprosencephaly; Humans; Hydrocephalus; Imaging, Three-Dimensional; Megalencephaly; Osteogenesis, Distraction; Skull; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt

Keywords

Child; Craniotomy; Female; Holoprosencephaly; Humans; Hydrocephalus; Imaging, Three-Dimensional; Megalencephaly; Osteogenesis, Distraction; Skull; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt

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