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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2015; 04(02): 085-091
DOI: 10.1055/s-0035-1558963
Original Article

Head Enlargement in Infants Requiring Neurosurgical Care

Sangh Mittra
1   Provincial Medical & Health Services, Chander Nagar, Alambagh, Lucknow, Uttar Pradesh, India
,
Rajnish Arora
2   Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Intezar Ahmed
3   Department of Pediatrics Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Raj Kumar
2   Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
4   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract

Head enlargement (macrocephaly) is not an uncommon neurosurgical condition in infants presenting to outpatient department and emergency departments of neurosurgery/gynecology/pediatrics. We conducted a prospective and retrospective study of head enlargement in infants requiring neurosurgical care, to establish etiology, imaging findings, clinical profile, and outcome, with emphasis on management. Over a period of 24 months, 65 cases presented with head enlargement.

All had a history of cranial expansion from neonatal period. Of 65 patients, 30 could match the inclusion criteria and were selected for this study. Age group ranged from 151 to 180 days, consisted maximum numbers (n = 10; 33.3%) of cases; of 30 23 (76.7%) patients were males. Of 30, 21 (70%) patients were diagnosed to have hydrocephalus, 4 (13.3%) had Dandy–Walker malformation, 2 (6.7%) had subdural effusion, and 3 cases (10%) had other causes as primary diagnoses. All were offered standard treatment as described in literature according to their clinical conditions and stage of diseases which included shunts (ventriculoperitoneal—unilateral, biventricular, and cystoventriculoperitonal), Ommaya placement, craniotomy, burr holes, and conservative. Four shunts required revision during follow-up period. The postoperative follow-up period ranged from 1 to 24 months. One child with the diagnosis of intracranial tumor died in postoperative period that is 1 month after the surgery due to disease-related morbidities. Thus, there are various causes of head enlargement in neonates where neurosurgical intervention may be required, the most common being the hydrocephalus, Dandy–Walker malformation followed by subdural effusion. The treatment depends on the diagnosis. Benign conditions such as subdural effusion do not require surgical intervention usually.

Keywords

macrocephaly - megalocephaly - head enlargement


Publication History

Received: 31 March 2015

Accepted: 25 May 2015

Publication Date:
28 July 2015 (online)

© 2015. Thieme. All rights reserved.

Neurological Surgeons' Society of India

 

  • References

  • 1 Biran-Gol Y, Malinger G, Cohen H. et al. Developmental outcome of isolated fetal macrocephaly. Ultrasound Obstet Gynecol 2010; 36 (02) 147-153
    Google Scholar
  • 2 DeMeyer W. Megalencephaly in children. Clinical syndromes, genetic patterns, and differential diagnosis from other causes of megalocephaly. Neurology 1972; 22 (06) 634-643
    Google Scholar
  • 3 Petersson S, Pedersen NL, Schalling M, Lavebratt C. Primary megalencephaly at birth and low intelligence level. Neurology 1999; 53 (06) 1254-1259
    Google Scholar
  • 4 Williams CA, Dagli A, Battaglia A. Genetic disorders associated with macrocephaly. Am J Med Genet A 2008; 146A (15) 2023-2037
    Google Scholar
  • 5 Dias MS, Myelomeningocele In: Choux M, Di Rocco C, Hockley AD, Walker ML. eds. Textbook of Paediatric Neurosurgery. 1st ed. Churchill Livingstone: 1999. 43. 253-269
    Google Scholar
  • 6 Farinha NJ, Razali KA, Holzel H, Morgan G, Novelli VM. Tuberculosis of the central nervous system in children: a 20-year survey. J Infect 2000; 41 (01) 61-68
    Google Scholar
  • 7 Shallat RF, Pawl RP, Jerva MJ. Significance of upward gaze palsy (Parinaud's syndrome) in hydrocephalus due to shunt malfunction. J Neurosurg 1973; 38 (06) 717-721
    Google Scholar
  • 8 Bayston R. Epidemiology, diagnosis, treatment, and prevention of cerebrospinal fluid shunt infections. Neurosurg Clin N Am 2001; 12 (04) 703-708 , viii
    Google Scholar
  • 9 Osenbach RK, Menezes AH. Diagnosis and management of the Dandy-Walker malformation: 30 years of experience. Pediatr Neurosurg 1992; 18 (04) 179-189
    Google Scholar
  • 10 Lipton HL, Preziosi TJ, Moses H. Adult onset of the Dandy-Walker syndrome. Arch Neurol 1978; 35 (10) 672-674
    Google Scholar
  • 11 Marinov M, Gabrovsky S, Undjian S. The Dandy-Walker syndrome: diagnostic and surgical considerations. Br J Neurosurg 1991; 5 (05) 475-483
    Google Scholar
  • 12 Mayhew JF, Miner ME, Denneny J. Upper airway obstruction following cyst-to-peritoneal shunt in a child with a Dandy-Walker cyst. Anesthesiology 1985; 62 (02) 183-184
    Google Scholar
  • 13 Naidich TP, Radkowski MA, McLone DG, Leestma J. Chronic cerebral herniation in shunted Dandy-Walker malformation. Radiology 1986; 158 (02) 431-434
    Google Scholar
  • 14 Odita JC. The widened frontal subarachnoid space. A CT comparative study between macrocephalic, microcephalic, and normocephalic infants and children. Childs Nerv Syst 1992; 8 (01) 36-39
    Google Scholar
  • 15 Minns RA. Subdural haemorrhages, haematomas, and effusions in infancy. Arch Dis Child 2005; 90 (09) 883-884
    Google Scholar
  • 16 Nickel RE, Gallenstein JS. Developmental prognosis for infants with benign enlargement of the subarachnoid spaces. Dev Med Child Neurol 1987; 29 (02) 181-186
    Google Scholar
  • 17 Kumar R. External hydrocephalus in small children. Childs Nerv Syst 2006; 22 (10) 1237-1241
    Google Scholar
  • 18 Kumar R, Singhal N, Mahapatra AK. Traumatic subdural effusions in children following minor head injury. Childs Nerv Syst 2008; 24 (12) 1391-1396
    Google Scholar
  • 19 Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Arch Dis Child 2005; 90 (09) 947-951
    Google Scholar
  • 20 Jaspan T, Griffiths PD, McConachie NS, Punt JA. Neuroimaging for non-accidental head injury in childhood: a proposed protocol. Clin Radiol 2003; 58 (01) 44-53
    Google Scholar
  • 21 Greenberg MS. Handbook of neurosurgery. 7th ed. New York, NY: Thieme Medical Publishers; 2010: 904-905
    Google Scholar
  • 22 McLaurin RL, Isaacs E, Lewis HP. Results of nonoperative treatment in 15 cases of infantile subdural hematoma. J Neurosurg 1971; 34 (06) 753-759
    Google Scholar
  • 23 Aoki N. Chronic subdural hematoma in infancy. Clinical analysis of 30 cases in the CT era. J Neurosurg 1990; 73 (02) 201-205
    Google Scholar