Reduction cranioplasty for craniocerebral disproportion in infancy: indications and technique

Craniocerebral disproportion is a gross discrepancy between the volume of the brain and the volume of the cranial cavity that persists after initial treatment of the underlying condition, which in most cases is severe congenital hydrocephalus. The goals of treatment are control of intracranial pressure and arrest of the growth of the head. These goals can usually be accomplished by cerebrospinal fluid shunts supplemented as needed by shunting of extracerebral fluid collections. When conventional methods fail, or when in the setting of extreme degrees of craniocerebral disproportion they seem doomed to failure, reduction cranioplasty may simplify management. A surgical technique is described, three cases are presented, and indications are discussed.