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Calcified cephalohematoma: classification, indications for surgery and techniques
Chin-Ho Wong1, Chee-Liam Foo, Wan-Tiew Seow
1Department of Plastic and Reconstructive Surgery, KK Women's and Children's Hospital, Singapore. wchinho@hotmail.com
Insights
Surgical management of calcified cephalohematoma is effective. This paper proposes a classification and algorithm to guide treatment decisions for this condition, improving patient outcomes.
Area of Science:
- Neurosurgery
- Pediatric Surgery
Background:
- Calcified cephalohematoma, a collection of blood on the skull, often requires intervention.
- Current literature lacks clear surgical indications and techniques for managing calcified cephalohematoma.
Observation:
- Three patients with large calcified parietal cephalohematomas underwent surgical correction.
- Surgical techniques included craniectomy and cranioplasty using cap radial craniectomy and flip-over bull's-eye methods.
Findings:
- A proposed classification system categorizes calcified cephalohematomas into Type 1 (normal inner lamella) and Type 2 (depressed inner lamella).
- An algorithm guides management based on presentation timing, calcification extent, and cephalohematoma type.
- Surgical intervention, including ostectomy or elevation of the inner lamella, yielded excellent outcomes.
Implications:
- The proposed algorithm provides a logical framework for managing calcified cephalohematomas.
- This approach can aid clinicians in selecting appropriate surgical techniques for optimal patient results.
- Further research may refine surgical strategies for complex calcified cephalohematoma cases.
Abstract:
While calcified cephalohematoma is eminently correctable, a clear description of indications for surgery and surgical techniques are currently lacking in the literature. In this paper we propose a simple classification and an algorithm for the management of cephalohematomas. Three patients were treated for large calcified parietal cephalohematomas. Craniectomy and cranioplasty were performed with excellent outcome. Cranioplasty was performed with the cap radial craniectomy technique in two patients and the flip-over bull's-eye technique in one patient. The literature was reviewed on this entity and an algorithm based on the timing of presentation, extent of calcification and type of calcified cephalohematoma is proposed. Aspiration and compressive dressings can be used for early, incompletely calcified cephalohematomas. Calcified cephalohematoma causing significant distortion of the calvarium requires surgical correction and is classified as Types 1 or 2 depending on the contour of the inner lamella. Type 1, with a normal contoured inner lamella, can be corrected by ostectomy of the outer lamella. Type 2 calcified cephalohematoma has a depressed inner lamella. Elevation of the inner lamella is necessary and the cap radial craniectomy technique can be used. We describe a novel technique, the flip-over bull's-eye techniques as an alternative technique for Type 2 lesions in selected patients. In conclusion, calcified cephalohematomas can safely be treated surgically with excellent outcome. It is hoped that this algorithm will serve as a useful and logical guide in decision making for the management of this condition.
