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Yoneoka Y, Seki Y, Akiyama K. Calvarium Subperiosteal Hematoma in a 12-Year-Old Boy. Cureus 2021; 13:e16550. [PMID: 34430157 PMCID: PMC8379556 DOI: 10.7759/cureus.16550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
Calvarium subperiosteal hematoma (C-SPOH) is extremely rare in juveniles. We present an extremely rare case of juvenile C-SPOH and a review of the literature. A 12-year-old boy hit his head hard against another player’s head during a soccer game. On the next day of the game (Day 02), he noticed a soft bump on the left parietal region. On Day 04, he saw a local physician and was diagnosed with a subgaleal hematoma. The hematoma grew larger, up to twice the size of that on Day 04 and it became more painful over the next five days. A CT scan on Day 10 showed a subcutaneous hematoma that did not cross the suture lines. Aspiration using a syringe with an 18-gauge needle obtained about 45 mL liquefied hematoma and caused the bump collapse with relief of the pain. On Day 12, however, he presented the same bump with similar pains as on Day 10. CT angiography revealed no vascular anomalies or disruptions. A blood sampling test demonstrated normal blood coagulation ability without thrombocytopenia or malnutrition. A second aspiration obtained 45 mL liquefied hematoma. In the second procedure, the hematoma cavity was irrigated with normal saline solution (about 5 mL x 4). He took 250 mg tranexamic acid three times a day and 5 mg prednisolone three times a day for four days. On Day 15, his C-SPOH was not tense and not painful. On Day 22, the periosteal hematoma remained soft and shrunk. A follow-up CT scan showed the complete disappearance of the subperiosteal hematoma on Day 57. The boy has returned to soccer-playing activity without sequelae. This case suggests that 1) C-SPOH can be found in healthy juveniles; 2) Neovascularization along the wall of the C-SPOH cavity may contribute to the formation of the C-SPOH; 3) A simple aspiration of the liquefied SPOH may fail to cure it in juveniles.
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Affiliation(s)
- Yuichiro Yoneoka
- Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, JPN
| | - Yasuhiro Seki
- Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, JPN
| | - Katsuhiko Akiyama
- Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, JPN
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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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Bilateral Cephalohematoma With Sagittal Synostosis and Scaphocephaly. J Craniofac Surg 2020; 31:e260-e261. [PMID: 32049914 DOI: 10.1097/scs.0000000000006223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Inappropriate fusion of the cranial sutures leads to craniosynostosis and the subsequent skull rigidity can cause many developmental and structural problems. Cephalohematoma is a subperiosteal collection of blood commonly associated with birth trauma or instrument-assisted delivery and is one of the most frequently reported fetal injuries in Caesarian section procedures. There have been very few cases reported of patients with both scaphocephaly due to sagittal craniosynostosis and cephalohematoma and no reports of scaphocephaly with bilateral cephalohematoma as of the date of this report. The current literature suggests that the two conditions are potentially associated, either through mechanical pathways involving trauma or through a complex interplay of growth factors. The authors present a case of bilateral cephalohematoma with scaphocephaly secondary to progressive sagittal craniosynostosis.
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Başağaoğlu B, St Cyr G, Dempsey RF, Dauser RC, Lam S, Maricevich RS. Chicken or the Egg: A Case Report of Endoscopic-Assisted Treatment of Concomitant Sagittal Craniosynostosis With Calcified Cephalohematoma. J Craniofac Surg 2019; 31:e130-e133. [PMID: 31688264 DOI: 10.1097/scs.0000000000006036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonsyndromic craniosynostosis results in premature fusion of cranial sutures and is rarely found in the context of other craniofacial abnormalities. Here the authors present the case of a 3-month-old male infant with a rare presentation of sagittal craniosynostosis and concomitant calcified cephalohematoma repaired by endoscopic-assisted sagittal strip craniectomy with good cosmetic and functional outcomes. The authors discuss the advantages of endoscopic repair of craniosynostosis when found in the presence of a cephalohematoma and the need for further research to investigate a possible causal relationship between these 2 pathologies.
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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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Endoscopic-assisted treatment of sagittal craniosynostosis and calcified cephalohematoma. J Craniofac Surg 2015; 25:2127-9. [PMID: 25329845 DOI: 10.1097/scs.0000000000001092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniosynostosis and its associated abnormalities can pose unique challenges to surgeons caring for these patients. Cephalohematomas, although rare, add to the complexities of managing a patient with craniosynostosis. Here, we present the case of a 4-month-old male infant with concurrent sagittal craniosynostosis and a calcified cephalohematoma who underwent an endoscopic-assisted strip craniectomy and management of the hematoma with good results.
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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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Abstract
In this paper, the author presents 2 cases of sagittal synostosis with scaphocephaly that featured ossified scalp hematomas straddling the sagittal suture in the midparietal region. These ossified lesions were originally cephalohematomas. Collection of blood under the pericranium across the midline was possible in these cases because sagittal synostosis had obliterated the sagittal suture and its dense attachment to overlying periosteum. Scaphocephaly very likely exacerbated the difficulty of the deliveries and contributed to the causation of the scalp hemorrhages. The alternative hypothesis, that ossification of a scalp hematoma immobilized the suture and caused synostosis, is not tenable for reasons that are reviewed. Sagittal synostosis in these 2 instances was not a complication of birth trauma.
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Affiliation(s)
- Joseph H Piatt
- Section of Neurosurgery, Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
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