A new method for the treatment of macrocephaly caused by hydrocephalus.

OBJECTIVE: This report will discuss a new surgical technique for treating severe cases of macrocephaly in which the bony architecture is markedly distorted. The procedure relies on several novel surgical tools for its success that have not been previously applied to the treatment of this condition. It utilized the use of contraction osteogenesis devices, resorbable plating systems, and an age- and sex-matched computer-generated skull model, which was derived from a computed tomographic scan as a template for the new calvarium.

RESULTS: In the case reported, combined use of these technologies allowed for the complete reconstruction of the calvarium down to the level of the cranial base to produce an appropriately sized skull. The skull model created a template onto which bony fragments could be placed and fixated into a normal shape using the resorbable plating system. The contraction osteogenesis devices then allowed for a slow, safe reduction of the hydrocephalus via a ventriculoperitoneal shunt over a period of several days. On completion of the contraction process, the devices served to fixate the calvarium to the cranial base during the period of bone healing.

CONCLUSION: 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.