title: Limited reduction cranioplasty for the treatment of hydrocephalic macrocephaly.
abstract: BACKGROUND
  Hydrocephalic macrocephaly, occurring despite adequate cerebrospinal fluid shunting, is rare, and most publications advocate near-total cranial vault reduction procedures. The authors reviewed our series of limited reductions (designed to minimize complications while still providing functional benefits) to evaluate outcomes.
  
  
  METHODS
  All patients undergoing posterior reduction cranioplasties were retrospectively reviewed for outcomes, including operative data, length of stay, preoperative and postoperative anthropometrics, and complications. In addition, preoperative and postoperative motor function was assessed using a novel scale. These data were then compared with published series.
  
  
  RESULTS
  Ten patients (five male, five female) underwent reduction cranioplasties for macrocephaly at an average age of 17.9 months (range, 6 to 53 months) and were followed for an average of 41.5 months. The mean operative time was 4.9 hours (range, 4.3 to 6.5 hours), estimated blood loss was 530 ml (range, 200 to 1500 ml), and 78 percent received blood transfusions. The average length of hospitalization was 2.6 days. Three patients experienced complications, including one shunt revision. The mean functional assessment scores increased from 2.3 to 3.9 (p = 0.022), with all patients able to support their heads postoperatively.
  
  
  CONCLUSIONS
  Use of a limited cranioplasty technique was associated with a hospitalization that was over 7 days shorter than has been reported in the literature for total cranial vault reductions and with a much lower shunt revision rate. Measurable improvements in motor function and subjective benefits in appearance were noted, despite a more limited reduction. Surgeons faced with this unusual condition may wish to consider performing this smaller procedure.
authors.affiliation: Dallas, Texas From The Craniofacial Center and Neurosurgeons for Children, Medical City Dallas Hospital.
authors.forename: Earl A
authors.initials: EA
authors.lastname: Gage
authors.forename: Angela V
authors.initials: AV
authors.lastname: Price
authors.forename: Dale M
authors.initials: DM
authors.lastname: Swift
authors.forename: David J
authors.initials: DJ
authors.lastname: Sacco
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Fearon
mesh_terms: D016063:Blood Loss, Surgical; D002508:Cephalometry; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007902:Length of Stay; D008297:Male; D058627:Megalencephaly / Q000601:surgery*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D016896:Treatment Outcome