CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2023; 12(01): 042-046
DOI: 10.1055/s-0041-1735377
Original Article

Craniomegaly in Neonate and Infants Requiring Neurosurgical Intervention: An Experience at Tertiary Care Center

Sangh Mittra
1   Department of Gynaecology, Veerangana Avanti Bai Mahila Chikitsalaya, Lucknow, Uttar Pradesh, India
2   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
Raj Kumar
2   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
› Author Affiliations
Funding None.


Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes.

Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants.

Materials and Methods The cases with a history of head enlargement from neonatal period were included in this study. Their causes, managements, and outcomes were recorded retrospectively during the period of January 2010 to February 2013, in neurosurgery department at SGPGIMS Lucknow, and June 2018 to June 2020, at UPUMS, Saifai, Etawah, UP, India.

Results Out of 41 cases, there were 30 (73.14%) cases of hydrocephalus, 4 (9.76%) Dandy-Walker malformation, 2 (4.88%) subdural collection, 2 (4.88%) arachnoid cyst, 1 (2.44%) craniosynostosis, and 2 (4.88%) with tubercular meningitis. The age range of our cases was 18 to 178 days and the mean age was 102.54 ± 50.73. Preoperative head circumference range was 39 to 62 cm (mean: 55.27 ± 6.58cm). Majority of the cases (n = 32, 78.05%) were managed with ventriculoperitoneal shunt surgeries. Out of 41 cases, 33(80.49%) had improved outcomes, 7 (17.07%) stabilized, and mortality occurred in 1 (2.44%) case. Postoperatively, there was improvement in the head circumference (range: 39–60 cm and mean: 46.15 ± 5.83 cm) on 6 to 24 months (mean: 17.85 ± 5.18 months) of follow-up.

Conclusion Hydrocephalus was the commonest neurosurgical cause of head enlargement in neonate and infants. Shunt surgery was the most common form of management of these cases. Early detection, institution of therapy, and periodic follow-up program for diagnosing and treating complications were the key to successful outcomes in these patients.

Authors' Contributions

Dr. Sangh Mittra performed data collection. The remaining authors contributing in writing of the manuscript.

Publication History

Article published online:
13 January 2022

© 2021. Neurological Surgeons' Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, 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
  • 2 DeMeyer W. Megalencephaly in children. Clinical syndromes, genetic patterns, and differential diagnosis from other causes of megalocephaly. Neurology 1972; 22 (06) 634-643
  • 3 Petersson S, Pedersen NL, Schalling M, Lavebratt C. Primary megalencephaly at birth and low intelligence level. Neurology 1999; 53 (06) 1254-1259
  • 4 Williams CA, Dagli A, Battaglia A. Genetic disorders associated with macrocephaly. Am J Med Genet A 2008; 146A (15) 2023-2037
  • 5 Desch LW, Anderson SK, Snow JH. Relationship of head circumference to measures of school performance. Clin Pediatr (Phila 1990; 29 (07) 389-392
  • 6 Dias MS. Myelomeningocele. In: Choux M, Di Rocco C, Hockley AD. eds. Paediatric Neurosurgery. London: Churchill Livingstone; 1999: 253-69
  • 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
  • 8 Schmidek HH, Auer LM, Kapp JP. The cerebral venous system. Neurosurgery 1985; 17 (04) 663-678
  • 9 Cozzens JW, Chandler JP. Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter. J Neurosurg 1997; 87 (05) 682-686
  • 10 Bayston R. Epidemiology, diagnosis, treatment, and prevention of cerebrospinal fluid shunt infections. Neurosurg Clin N Am 2001; 12 (04) 703-708, viii
  • 11 Marinov M, Gabrovsky S, Undjian S. The Dandy-Walker syndrome: diagnostic and surgical considerations. Br J Neurosurg 1991; 5 (05) 475-483
  • 12 Bindal AK, Storrs BB, McLone DG. Management of the Dandy-Walker syndrome. Pediatr Neurosurg 1990; -1991 16 (03) 163-169
  • 13 Domingo Z, Peter J. Midline developmental abnormalities of the posterior fossa: correlation of classification with outcome. Pediatr Neurosurg 1996; 24 (03) 111-118
  • 14 Kalidasan V, Carroll T, Allcutt D, Fitzgerald RJ. The Dandy-Walker syndrome–a 10-year experience of its management and outcome. Eur J Pediatr Surg 1995; 5 (Suppl. 01) 16-18
  • 15 Greenberg MS. Handbook of Neurosurgery. 7th edition.. New York: Thieme Medical Publishers; 2010: 904-905
  • 16 Aoki N. Chronic subdural hematoma in infancy. Clinical analysis of 30 cases in the CT era. J Neurosurg 1990; 73 (02) 201-205