title: Correction of hydrocephalic macrocephaly with total cranial vault remodeling and molding helmet therapy.
abstract: BACKGROUND
  Hydrocephalic macrocephaly is a rare problem that may result in cranial vault instability, difficulties with posture and movement, and hindrance in neurological development. The authors studied the outcomes of hydrocephalic macrocephalic cases in which patients underwent single-stage total cranial vault remodeling and postoperative helmet therapy.
  
  
  METHODS
  Consecutive patients with hydrocephalic macrocephaly treated at University of California, Los Angeles from 2000 to 2007 were studied (n = 8). Perioperative examinations (head circumference), lateral cranial radiographs (anteroposterior, lateral, and cranial height measurements) and three-dimensional computed tomography scans (cranial volume) were used to access cranial reduction. Developmental testing, physician evaluations (Whitaker score), and parental surveys were used.
  
  
  RESULTS
  Improvements in mean head circumference (from 58.8 cm to 48.9 cm, or 17 percent reduction), and cranial volume measurements (from 1924 cc to 1212 cc, or 35 percent reduction) were seen in patients after the procedure. In addition, developmental testing scores improved in half, or four of eight patients. Whitaker score was 1.9 with only one case requiring revision but five needing subsequent shunts. Surveys showed a high satisfaction rate with final appearance and ease of childcare.
  
  
  CONCLUSIONS
  For the rare patient with hydrocephalic macrocephaly, treatment with total cranial vault remodeling with postoperative helmet therapy may be successful, but follow-up monitoring and subsequent ventriculoperitoneal shunting may be necessary.
authors: Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA.
authors: Emil
authors: E
authors: Kohan
authors: Eric
authors: E
authors: Jackson
authors: Justin
authors: J
authors: Heller
authors: Jorge
authors: J
authors: Lazareff
authors: James P
authors: JP
authors: Bradley
mesh_terms: D002508:Cephalometry; D002557:Cerebrospinal Fluid Shunts; D003131:Combined Modality Therapy; D019465:Craniofacial Abnormalities / Q000209:etiology / Q000601:surgery / Q000628:therapy; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000601:surgery; D007223:Infant; D008297:Male; D009989:Orthotic Devices; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome