title: Cranial reduction and fixation with a resorbable plate combined with cerebrospinal fluid shunting for difficult-to-manage macrocephaly related to hydrocephalus.
abstract: 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.
authors.affiliation: Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Jotham C
authors.initials: JC
authors.lastname: Manwaring
authors.forename: Devon
authors.initials: D
authors.lastname: Truong
authors.forename: Armen R
authors.initials: AR
authors.lastname: Deukmedjian
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Carey
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Storrs
authors.forename: Luis F
authors.initials: LF
authors.lastname: Rodriguez
authors.forename: Lisa
authors.initials: L
authors.lastname: Tetreault
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Tuite
mesh_terms: D001504:Beauty; D001860:Bone Plates / Q000706:statistics & numerical data*; D061345:Early Medical Intervention / Q000379:methods; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D058627:Megalencephaly / Q000209:etiology* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt