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Published on: August 11, 2015
Reduction cranioplasty for hydrocephalic macrocephaly: a systematic review of surgical outcomes
Steven P Moura1,2, Alexandra D Center1, Manasa Kalluri1
11Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Reduction cranioplasty improves head size, positioning, and cosmesis in hydrocephalic macrocephaly. However, risks like blood loss and complications necessitate careful surgical planning.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Craniofacial Surgery
Background:
- Hydrocephalic macrocephaly presents challenges including poor psychosocial development, positioning difficulties, skin breakdown, and cosmetic concerns.
- Reduction cranioplasty offers a potential solution for these sequelae.
- Limited understanding exists regarding postoperative outcomes, complications, and mortality associated with this rare condition.
Conclusions:
- Reduction cranioplasty generally leads to improved head size, positioning, cranial cosmesis, and neurological function in patients with hydrocephalic macrocephaly.
- The prevalence of lower-level evidence, significant blood loss, complications, and mortality underscores the need for careful surgical indication, experienced surgical teams, and meticulous perioperative planning.
- These complex surgeries require a thorough discussion of risks and benefits before proceeding.
Objective:
Hydrocephalic macrocephaly can result in poor psychosocial development, positioning difficulties, skin breakdown, and poor cosmesis. Although reduction cranioplasty can address these sequelae, the postoperative outcomes, complications, and mortality risk of reduction cranioplasty are not well understood given the rarity of hydrocephalic macrocephaly. Therefore, the primary objective of this systematic review was to evaluate the surgical outcomes of reduction cranioplasty for the treatment of hydrocephalic macrocephaly.
Methods:
A systematic review was performed using the PubMed, Scopus, and Web of Science databases while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened 350 studies; 27 studies reporting surgical outcomes on reduction cranioplasty for hydrocephalic macrocephaly met inclusion criteria. Data on study design, patient demographics, operative details, and surgical outcomes were collected.
Results:
There were 65 reduction cranioplasties among the 27 included studies. Eighteen (66.7%) studies presented level V evidence, 7 (25.9%) presented level IV evidence, and 2 (7.4%) presented level III evidence. Following reduction cranioplasty, there was improvement in postoperative head positioning in 23 (85.2%) studies, improvement in postoperative cosmesis in 22 (81.5%) studies, and improvement in global postoperative neurological functioning in 20 (74.1%) studies. The median estimated blood loss was 633 mL (range 20-2600 mL). Shunt revisions were the most common complication, reported in 9 (47.4%) of the 19 studies assessing complications. Of the 65 patients, there was a mortality rate of 6.2% (n = 4).
Conclusions:
The majority of the included studies reported improvement in head size, head positioning, cranial cosmesis, and global neurological functioning following reduction cranioplasty for hydrocephalic macrocephaly. However, the prevalence of lower-level evidence, risk of blood loss, complications, and mortality indicates the need for a serious discussion of surgical indication, an experienced team, and thorough perioperative planning to perform these complex surgeries.
