Reverse Distraction for Treatment of Hydrocephalic Macrocephaly in Late Childhood

Area of Science:

• Pediatric Neurosurgery
• Craniofacial Surgery
• Medical Technology

Background:

• Macrocephaly significantly impacts children's quality of life, affecting mobility and social interaction.
• Traditional cranial reduction methods carry high risks, including bleeding and shunt complications.
• Severe macrocephaly, often linked to conditions like holoprosencephaly and hydrocephalus, requires effective treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of reverse distraction osteogenesis for cranial reduction in a pediatric patient with severe macrocephaly.
• To present the case of the oldest patient with macrocephaly treated using this technique.

Main Methods:

• A 9-year-old girl with holoprosencephaly and severe macrocephaly underwent cranial reduction using reverse distraction osteogenesis.
• The procedure involved circumferential craniotomy, placement of cranial distractors, followed by distractor removal and cranioplasty with resorbable fixation.

Main Results:

• The patient experienced significant postoperative improvements in head control and engagement in school activities.
• This represents the oldest reported case of macrocephaly treated with reverse distraction osteogenesis.

Conclusions:

• Reverse distraction osteogenesis provides a safe and effective method for cranial reduction in children with profound macrocephaly.
• The technique's gradual cranial vault contraction and limited initial bony surgery enhance safety, making it suitable for older children.