Correction of Macrocephaly using Sagittal Hinge Flap

Abstract

Macrocephaly commonly occurs in children with untreated or neglected hydrocephalus, and in most cases this is accompanied with discrepancy between the volume of the brain and the cranial cavity. Macrocephaly usually interferes with head control, seating, locomotion, and social acceptance. So the goals of the reduction cranioplasty lie in reconstruction of the head shape, control of intracranial pressure, obstruction of the growth of the head, which enables to ambulate. However, reports about surgery of macrocephaly are scanty. A 24-month-old girl suffered from hydrocephalus with macrocephaly. Her head circumference was 71cm and couldn't control her head or lie in lateral position. The surgical technique we used was a one-stage operation, using a sagittal hinge flap. This technique includes infracturing with wedge resection of the marginal skull and pushing it inward. The dura mater in the frontal region was plicated, while care was taken to maintain attachment of the superior sagittal sinus, the fixation was done with microplates, screws and wirings. After the operation, she had no air embolism, venous infarction, infection, neurologic deficit and had satisfactory cosmetic results. History of the operation of macrocephaly, tactical considerations and possible risks are discussed with our surgical experience in this publication.