Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA.
Plast Reconstr Surg. 2010 Jun;125(6):1763-1770. doi: 10.1097/PRS.0b013e3181cc5a1b.
Hydrocephalic macrocephaly is a rare problem that may result in cranial vault instability, difficulties with posture and movement, and hindrance in neurological development. The authors studied the outcomes of hydrocephalic macrocephalic cases in which patients underwent single-stage total cranial vault remodeling and postoperative helmet therapy.
Consecutive patients with hydrocephalic macrocephaly treated at University of California, Los Angeles from 2000 to 2007 were studied (n = 8). Perioperative examinations (head circumference), lateral cranial radiographs (anteroposterior, lateral, and cranial height measurements) and three-dimensional computed tomography scans (cranial volume) were used to access cranial reduction. Developmental testing, physician evaluations (Whitaker score), and parental surveys were used.
Improvements in mean head circumference (from 58.8 cm to 48.9 cm, or 17 percent reduction), and cranial volume measurements (from 1924 cc to 1212 cc, or 35 percent reduction) were seen in patients after the procedure. In addition, developmental testing scores improved in half, or four of eight patients. Whitaker score was 1.9 with only one case requiring revision but five needing subsequent shunts. Surveys showed a high satisfaction rate with final appearance and ease of childcare.
For the rare patient with hydrocephalic macrocephaly, treatment with total cranial vault remodeling with postoperative helmet therapy may be successful, but follow-up monitoring and subsequent ventriculoperitoneal shunting may be necessary.
脑积水性大头畸形是一种罕见的问题，可能导致颅顶不稳定、姿势和运动困难以及神经发育受阻。作者研究了接受单阶段全颅顶重塑和术后头盔治疗的脑积水性大头畸形患者的结果。
对 2000 年至 2007 年在美国加利福尼亚大学洛杉矶分校接受治疗的连续脑积水性大头畸形患者（n=8）进行了研究。使用术前检查（头围）、侧颅射线照相（前后位、侧位和颅高测量）和三维计算机断层扫描（颅容积）来评估颅顶缩小。使用发育测试、医生评估（惠特克评分）和家长调查。
术后患者的平均头围（从 58.8 厘米降至 48.9 厘米，或缩小 17%）和颅容积测量值（从 1924cc 降至 1212cc，或缩小 35%）均有所改善。此外，一半（8 例中的 4 例）患者的发育测试评分有所提高。惠特克评分为 1.9，仅 1 例需要修订，但 5 例需要后续分流。调查显示，患者对最终外观和照顾孩子的便利性非常满意。
对于罕见的脑积水性大头畸形患者，采用全颅顶重塑术联合术后头盔治疗可能是成功的，但需要进行随访监测和后续脑室腹腔分流术。
