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Successful treatment of post-shunt craniocerebral disproportion by coupling gradual external cranial vault distraction with continuous intracranial pressure monitoring

Report of 2 cases

Adam L. Sandler, Lawrence B. Daniels III, David A. Staffenberg, Eliezer Kolatch, James T. Goodrich, and Rick Abbott

, Denny AD : Internal distraction osteogenesis to correct symptomatic cephalocranial disproportion . Plast Reconstr Surg 126 : 1677 – 1688 , 2010 10.1097/PRS.0b013e3181ef8f65 17 Martínez-Lage JF , Ruiz-Espejo Vilar A , Pérez-Espejo MA , Almagro MJ , Ros de San Pedro J , Felipe Murcia M : Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures . Neurosurg Rev 29 : 229 – 235 , 2006 10.1007/s10143-006-0022-z 18 Risberg J , Lundberg N , Ingvar DH : Regional cerebral blood volume during acute

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Globular subdural hematoma in a shunt-treated infant

Case report

Takahiro Murata, Hiroaki Shigeta, Tetsuyoshi Horiuchi, Keiichi Sakai, and Kazuhiro Hongo

from an enlarged vein in the subdural zone. 7 , 11 The incidence of SDH after placement of a programmable-valve VP shunt has been reported to be about 5.1–6.2%. 2 , 12 Patients with “craniocerebral disproportion” (that is, long-standing hydrocephalus with a large head and little brain parenchyma with a thin cerebral mantle) are predisposed to developing an SDH. 5 , 8 When the brain has a thin cerebral mantle, it may be loose and less capable of thickening after shunt insertion, and the brain is more mobile. In this context, the brain is more susceptible to a

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Treatment of hydrocephalus and bilateral subdural effusions in a patient with closed sutures

Case report

Selvadurai Sivalingam and Guy Corkill

M assive bilateral subdural hemorrhage or effusions are common in infancy. The skull sutures are unfused and management by tapping 1 and external drainage often succeeds despite apparent massive craniocerebral disproportion. This success is due to the molding of the developing skull to the underlying brain and its partial expansion. A different situation exists if the skull sutures are fused, as in previously compensated hydrocephalus. Should the hydrocephalus become decompensated and be treated by shunting, it is well recognized that a subdural effusion may

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A pitfall in the diagnosis of child abuse: external hydrocephalus, subdural hematoma, and retinal hemorrhages

Joseph H. Piatt Jr

External hydrocephalus has been associated with subdural hematomas in infancy, and the hematomas have been noted to be secondary to minor trauma or have even been described as spontaneous. The author reports the case of an infant with external hydrocephalus who developed retinal as well as subdural hemorrhages after sustaining a minor head injury. Although retinal hemorrhage in infancy has been considered virtually pathognomonic of child abuse, in the setting of external hydrocephalus a more cautious interpretation may be appropriate.

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Raised intracranial pressure in Crouzon syndrome: incidence, causes, and management

Ghassan S. Abu-Sittah, Owase Jeelani, David Dunaway, and Richard Hayward

also well recognized. 3 The incidence of raised intracranial pressure (ICP) in untreated cases of CS has been reported as 62.5%. 22 Possible consequences include visual loss that can extend to blindness 6 , 15 , 18 , 30 as well as impaired neurocognitive development. 23 The causes of raised ICP are multiple. Although once attributed to craniocerebral disproportion (CCD), 23 this has largely been discounted since the measurement of intracranial volume became available 10 , 11 , 27 (except for patients under the age of 1 year 28 and those whose skull growth

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Pilot study of intracranial venous physiology in craniosynostosis

Martijn J. Cornelissen, Robbin de Goederen, Priya Doerga, Iris Cuperus, Marie-Lise van Veelen, Maarten Lequin, Paul Govaert, Irene M. J. Mathijssen, Jeroen Dudink, and Robert C. Tasker

C raniosynostosis occurs in approximately 1 in 1500 births and results in abnormal shape of the cranium and increased risk of intracranial hypertension (ICHT). 1 In published series, the prevalence of ICHT ranges from 1% to 85%, and it is particularly high in syndromic cases of craniosynostosis. 2 , 3 , 13 , 17 Historically, the development of ICHT in craniosynostosis was attributed solely to skull growth restriction (i.e., craniocerebral disproportion). 18 Now, however, the accumulated evidence suggests that other factors may also be relevant, 5 , 6 , 8 , 9

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The occipitofrontal circumference: reliable prediction of the intracranial volume in children with syndromic and complex craniosynostosis

Bianca Francisca Maria Rijken, Bianca Kelly den Ottelander, Marie-Lise Charlotte van Veelen, Maarten Hans Lequin, and Irene Margreet Jacqueline Mathijssen

sutures are involved. Preoperatively, 40%–50% of the patients with Apert syndrome, 50%–70% of those with Crouzon-Pfeiffer syndrome, 35%–45% of those with Saethre-Chotzen syndrome, 50%–80% of the patients with complex craniosynostosis, and none of those with Muenke syndrome develop increased ICP. 5 , 12 , 13 , 15 , 18 , 21 , 24 , 25 , 29 , 30 , 32 Postoperatively, 35%–43% of patients still develop raised ICP. 12 , 13 , 15 , 18 , 25 , 29 , 30 Factors influencing ICP in these patients include craniocerebral disproportion (a condition in which the brain grows faster

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Abstracts for the 2014 Annual Meeting of The American Society of Pediatric Neurosurgeons

. J Neurosurg Pediatr Journal of Neurosurgery: Pediatrics PED 1933-0707 1933-0715 American Association of Neurological Surgeons 10.3171/2014.1.PEDSpaper24 PED.2014.36.3.2 Abstract Wednesday's Abstracts Paper 24: Chiari I, a Subcategory of Craniocerebral Disproportion: Alleviation by Supratentorial Cranial Vault Expansion

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Letter to the Editor. Altered intracranial venous physiology

Surya Sri Krishna Gour, Mohit Agrawal, and Dattaraj Sawarkar

), altered cranial venous outflow, and craniocerebral disproportion (CCD); these factors are known to contribute to raised ICP in patients with syndromic craniosynostosis, 3 and thus may confound the results. Doppler assessment is highly operator dependent and is affected by various factors like level of activity and head end elevation. 4 In this study, measurements were taken at various degrees of head end elevation (0°–30°) and also could not be performed in a few patients in the postoperative period due to lack of a radiological window. The use of noninvasive

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Gamma-Ray Image of Subdural Effusions

Scanning after Injection of Radio-Iodinated Serum Albumin into Subdural Space and Its Clinical Application

John Mealey Jr.

months earlier. Multiple burr holes at that time disclosed no significant residual hematoma, and no membranes were recognized. She returned with obvious recurrent effusions with marked subgaleal extensions of the collection of subdural fluid on the left side, through the burr holes. This is represented diagrammatically on the scans. Fig. 2. Lateral ( above ) and sagittal ( below ) scans of large recurrent left subdural hematoma in infant L.C. The scans of L.C. demonstrate the extreme craniocerebral disproportion present with an extensive layer of