Head Enlargement in Infants Requiring Neurosurgical Care

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)

• 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 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
• 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
• 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 Bayston R. Epidemiology, diagnosis, treatment, and prevention of cerebrospinal fluid shunt infections. Neurosurg Clin N Am 2001; 12 (04) 703-708 , viii
• 9 Osenbach RK, Menezes AH. Diagnosis and management of the Dandy-Walker malformation: 30 years of experience. Pediatr Neurosurg 1992; 18 (04) 179-189
• 10 Lipton HL, Preziosi TJ, Moses H. Adult onset of the Dandy-Walker syndrome. Arch Neurol 1978; 35 (10) 672-674
• 11 Marinov M, Gabrovsky S, Undjian S. The Dandy-Walker syndrome: diagnostic and surgical considerations. Br J Neurosurg 1991; 5 (05) 475-483
• 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
• 13 Naidich TP, Radkowski MA, McLone DG, Leestma J. Chronic cerebral herniation in shunted Dandy-Walker malformation. Radiology 1986; 158 (02) 431-434
• 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
• 15 Minns RA. Subdural haemorrhages, haematomas, and effusions in infancy. Arch Dis Child 2005; 90 (09) 883-884
• 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
• 17 Kumar R. External hydrocephalus in small children. Childs Nerv Syst 2006; 22 (10) 1237-1241
• 18 Kumar R, Singhal N, Mahapatra AK. Traumatic subdural effusions in children following minor head injury. Childs Nerv Syst 2008; 24 (12) 1391-1396
• 19 Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Arch Dis Child 2005; 90 (09) 947-951
• 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
• 21 Greenberg MS. Handbook of neurosurgery. 7th ed. New York, NY: Thieme Medical Publishers; 2010: 904-905
• 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
• 23 Aoki N. Chronic subdural hematoma in infancy. Clinical analysis of 30 cases in the CT era. J Neurosurg 1990; 73 (02) 201-205