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Management of Calcified Cephalohematoma of Infancy: The University of Michigan 25-Year Experience. Plast Reconstr Surg 2021; 148:409-417. [PMID: 34398092 DOI: 10.1097/prs.0000000000008199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cephalohematoma of infancy is the result of a subperiosteal blood collection that usually forms during birth-related trauma. A small proportion of cephalohematomas can calcify over time, causing a permanent calvarial deformity that is only correctable with surgery. The authors present a technique for the excision and reconstruction of calcified cephalohematoma and their management experience over the past 25 years. METHODS All patients with a diagnosis of calcified cephalohematoma between 1994 and 2019 were identified. Patients were included if the diagnosis was confirmed by a pediatric plastic surgeon or a neurosurgeon. All patients underwent surgical evaluation followed by surgical intervention or observation. Patient demographics and potential risk factors for both surgical and nonsurgical groups were compared using chi-square or Fisher's exact test. Additional data were collected for the surgical cohort. RESULTS Of 160 infants diagnosed with cephalohematoma, 72 met inclusion criteria. Thirty patients underwent surgical treatment. There was no significant difference in demographics, baseline characteristics, or potential risk factors between the operative and nonoperative groups. Mean age at the time of surgery was 8.6 months. Twenty-one surgical patients (70 percent) required inlay bone grafting. All surgery patients had improvement in calvarial shape. The main risk of surgery was blood loss requiring transfusion [eight patients (26.7 percent)]. Thirteen percent of patients experienced minor complications. CONCLUSIONS This series of 72 children with calcified cephalohematomas, 30 of whom required surgical intervention, is one of the largest to date. The technique presented herein demonstrated excellent surgical outcomes by restoring normal cranial contours and was associated with a low complication profile. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Üçer M, Taçyıldız AE, Aydın I, Akkoyun Kayran N, Işık S. Observational Case Analysis of Neonates With Large Cephalohematoma. Cureus 2021; 13:e14415. [PMID: 33987064 PMCID: PMC8112209 DOI: 10.7759/cureus.14415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Cephalohematomas in the newborn period are related to the accumulation of blood between the bone and periosteum as a result of a series of adverse conditions during labor. The optimal approach to cephalohematoma cases is still unclear. In this study, we aimed to present the follow-up data of 94 newborns with a cephalohematoma size of >50 mm and a higher risk of ossification. Methods This is a single-center, non-randomized, prospective, observational study conducted from May 2014 to May 2019. Records of all newborns with cephalohematoma were reviewed in terms of gender, birth weight, cephalohematoma region, transverse/vertical diameter of the lesion, delivery method, and rate of ossification. Results The girl-to-boy ratio was 53/41, with a mean gestational age of 38.3±1.4 weeks and a mean birth weight of 3,300±800 grams. The mean transverse/vertical diameter of cephalohematoma was 59±9 mm. Cephalohematoma was completely resorbed at the first-month control visits in 72 (76.6%) cases, whereas nine (9.57%) had an ossified cephalohematoma. The ossification was completely or partially resorbed in these at the end of the one-year follow-up. Conclusion Hence, we suggest that an early intervention is not required in the routine treatment of cases with hematomas with a size of >50 mm in size unless otherwise stipulated with clinical indications.
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Affiliation(s)
- Melih Üçer
- Neurosurgery, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, TUR
| | | | - Ilhan Aydın
- Neurosurgery, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, TUR
| | - Nesrin Akkoyun Kayran
- Neurosurgery, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, TUR
| | - Semra Işık
- Neurosurgery, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, TUR
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Calloni T, Trezza A, Mazzoleni F, Cavaliere M, Canonico F, Sganzerla E, Giussani C. Infant ossified cephalohematoma: a review of the surgical management and technical update. J Neurosurg Sci 2021; 64:552-557. [PMID: 33463977 DOI: 10.23736/s0390-5616.20.05052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cephalohematoma is a subperiosteal collection of blood above the skull. It is associated with operative and prolonged deliveries. In most cases the hematoma spontaneously resolves in a short span of time, usually within one month. In a few cases cephalohematoma can become ossified and require surgical treatment. Traditional belief that ossified cephalohematomas are an exclusively cosmetic issue has been called into question by recent description of EEG anomalies associated to a calcified cephalohematoma. We review relevant surgical literature, and we describe a novel variant of Wong's Radial Cap technique by foregoing healthy bone margin removal, removing the cephalohematoma lamellae in a stepwise fashion and using resorbable plaques for fixation. We furthermore review the rationale, timing and step-by-step execution of the procedure. An exemplary case description is discussed.
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Affiliation(s)
- Tommaso Calloni
- School of Medicine, University of Milano-Bicocca, Milan, Italy - .,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy -
| | - Andrea Trezza
- Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Fabio Mazzoleni
- Unit of Maxillo-Facial Surgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Marilou Cavaliere
- School of Medicine, University of Milano-Bicocca, Milan, Italy.,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Francesco Canonico
- Unit of Neuroradiology, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Erik Sganzerla
- School of Medicine, University of Milano-Bicocca, Milan, Italy.,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
| | - Carlo Giussani
- School of Medicine, University of Milano-Bicocca, Milan, Italy.,Unit of Neurosurgery, San Gerardo Hospital, ASST Monza, Monza, Monza-Brianza, Italy
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Abstract
BACKGROUND Cephalohematoma is collection of blood between skull and periosteum that is confined by cranial sutures. Cephalohematomas usually resorb spontaneously within the first month of life; however, if it fails to resolve, ossified cephalohematoma may form. METHODS Clinical archiving system and picture archiving and communication system were retrospectively reviewed for cases of birth-related cephalohematoma. Cases of ossified cephalohematomas identified on imaging were retrieved from this subset of patients. Cross-sectional imaging findings in patients with ossified cephalohematomas were evaluated for location, size of the hematoma, and contours of the inner lamella. RESULTS Out of 115 cases of cephalohematoma, 7 cases had imaging findings consistent with ossified cephalohematoma. All ossified cephalohematomas were located parietally, with size ranging between 18 and 55 mm and the thickness of the outer rim of calcification ranging between 1.5 and 4.8 mm. The contour of inner lamella in relation to the surrounding normal cranial vault was normal in 5 cases, and inner lamella was depressed in 2 cases.Three patients had follow-up imaging available for demonstration of changes in ossified cephalohematoma. The first case was an 11 day-old boy with a cephalohematoma with no signs of calcification at the time of initial imaging. Follow-up at 2 months of age showed partial regression of hematoma cavity with marked calcification at the hematoma walls. The second case was a 3 month-old boy with ossified cephalohematoma at initial imaging. Follow-up imaging at 7 months of age showed almost total regression of hematoma cavity, and approximation of inner and outer lamella with increased thickness of the cranial vault. The third case was a 1 month-old boy with ossified cephalohematoma at initial imaging that totally resolved without residual increased bone thickness at 21-month follow-up. CONCLUSION These 3 cases demonstrate the variability in temporal changes that may occur in ossified cephalohematomas.
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Liby P, Lomachinsky V, Felici G, Vaculik M, Krasnicanova H, Tichy M. Sagittal craniosynostosis associated with midline cephalhematoma or vice versa, case report and a review of the literature. Childs Nerv Syst 2019; 35:729-732. [PMID: 30539297 DOI: 10.1007/s00381-018-4020-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Sagittal craniosynostosis associated with midline cephalhematoma is a rare finding. Despite the controversy regarding its etiopathogenesis, this condition represents a clear indication for surgery. CASE REPORT We present a case of a 10-week-old boy with an ossified midline vertex cephalhematoma and sagittal craniosynostosis. The child underwent a cephalhematoma excision and minimally invasive non-endoscopic narrow vertex craniectomy, with calvarial vault remodeling followed by 2 weeks use of a cranial orthosis. On 5-month follow-up, mesocephaly was achieved. CONCLUSION Our case is well documented with native CT, 3D CT, intraoperative pictures, and 3D head scan imaging. We described our minimally invasive non-endoscopic technique that led to a rapid cranial vault remodeling with reduction of cranial orthosis need. A review of literature focused on surgical techniques is included.
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Affiliation(s)
- Petr Liby
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
| | - V Lomachinsky
- Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - G Felici
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.,Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Vaculik
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - H Krasnicanova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - M Tichy
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic
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Shtaya A, Almousa A, Dabbous B. A rare case of a calcified cephalhematoma mistaken as a skull fracture. Pediatr Neonatol 2018; 59:221-222. [PMID: 29191742 DOI: 10.1016/j.pedneo.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; Atkinson Morley Neurosurgery Centre, St George's University Hospital NHS Trust, London, UK.
| | - Ala'a Almousa
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Bassam Dabbous
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Vigo V, Battaglia DI, Frassanito P, Tamburrini G, Caldarelli M, Massimi L. Calcified cephalohematoma as an unusual cause of EEG anomalies: case report. J Neurosurg Pediatr 2017; 19:46-50. [PMID: 27715482 DOI: 10.3171/2016.6.peds16120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cephalohematoma, one of the most common neonatal head injuries, generally undergoes spontaneous resorption. When calcified, it may cause cranial vault distortion and depression of the inner skull layer, although it remains asymptomatic. Surgery, indeed, is usually performed for cosmetic purposes. For these reasons, the long-term effects of calcified cephalohematoma (CC) are widely unknown. The authors report the case of an 11-year-old girl with a persistent calcified CC causing skull deformity and delayed electroencephalography (EEG) anomalies. These anomalies were detected during routine control EEG and were not clinically evident. The young girl underwent surgical removal of the CC for cosmetic purpose. The EEG abnormalities disappeared after surgery, thus reinforcing the hypothesis of a correlation with the brain "compression" resulting from the CC. To the best of the authors' knowledge this is the first time that CC-associated EEG anomalies have been described: even though these anomalies cannot be considered an indication for surgery, they merit late follow-up in case of skull deformity.
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Affiliation(s)
- Vera Vigo
- Departments of 1 Pediatric Neurosurgery and
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Ossification of subperiosteal hematoma: the potential of periosteal osteogenesis in cranioplasty. J Craniofac Surg 2015; 24:1603-5. [PMID: 24036735 DOI: 10.1097/scs.0b013e3182a20ffb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Subperiosteal hematoma is the accumulation of blood between the periosteum and the skull, which commonly occurs in the neonatal period but rarely in other ages. Subperiosteal hematoma can be self-absorbed in most cases and occasionally may cause ossification. MATERIALS AND METHODS This study reports a case of subperiosteal hematoma formed in a 16-year-old adolescent boy after a minor trauma. Because the hematoma did not disappear for more than a month after the trauma, the patient was treated with multiple hematoma punctures. However, the hematoma recurred and led to ossification. Finally, the patient underwent surgical treatment. RESULTS Finally, the ossification associated with the hematoma was treated through surgery. The head contour recovered normally. CONCLUSIONS The occurrence of hematoma ossification in the 16-year-old patient suggests that the periosteum has great potential for osteogenesis. This is likely caused by the joint action of some active factors in the blood and a certain tension of the hematoma on the local periosteum. This case provides the following thoughts. (1) A subperiosteal hematoma that has not been absorbed after 1 month should be treated promptly to avoid ossification. Once ossification has occurred, the hematoma should be treated surgically. (2) The potential for periosteal osteogenesis is great, which may provide a new thought for cranioplasty.
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Yoon SD, Cho BM, Oh SM, Park SH. Spontaneous resorption of calcified cephalhematoma in a 9-month-old child: case report. Childs Nerv Syst 2013; 29:517-9. [PMID: 23292440 DOI: 10.1007/s00381-012-2008-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/16/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Sang-Duck Yoon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #445, Gil-dong, Gangdong-gu, Seoul 134-701, South Korea
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Chronic ossified subperiosteal hematoma of the skull in an 11-year-old child: a case report. Childs Nerv Syst 2011; 27:1165-8. [PMID: 21400227 DOI: 10.1007/s00381-011-1420-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
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