Simple excision and periosteal reattachment for the treatment of calcified cephalhematoma

Ossified Encapsulated Cephalhematoma

ABSTRACT

Ossified cephalhematoma is a rare congenital condition that may be found if newborn cephalhematoma is not resolved. Here, however, the authors report an exceptional case of an 8-month-old baby presenting with an ossified cephalhematoma in the right parieto-occipital area. Pre-operative imaging showed a calcified subperiosteal hematoma. He underwent hematoma excision with bone contouring procedures. A histopathological study showed hemosiderin-laden macrophages with blood and pseudocyst walls. The authors also discuss the possible pathogenesis of the ossified cephalhematoma and its treatment.

Ossified Cephalhematoma: An Unusual Cause of Calvarial Mass in Infancy

Cephalhematomas occurring in newborn usually resolve within a month. Rarely, they tend to ossify and present as hard scalp swelling. Unless one is aware of this possibility, this condition may be misinterpreted as bony tumor and cause needless apprehension to parents as well as the treating physician. A suspicion that ossified cephalhematoma (OC) could present in such a manner supported by careful history taking and relevant imaging (X-ray/computed tomography) would help in appropriate evaluation of this benign condition. The management of OC is controversial. Occasionally, they undergo spontaneous remodeling. Those with secondary craniosynostosis and/or disfigurement are treated surgically. Simple ossified lesions with no significant cosmetic issues may be conservatively tackled. We report such a case in a 3-month-old child. The other management options are briefly discussed.

Early neurosurgical treatment of cephalhaematomas-personal experience and review of the literature

OBJECTIVE

A group of 123 children suffering from cephalhaematoma were treated at the Clinic of Pediatric Surgery, Orthopaedics and Traumatology in Brno Faculty Hospital within 5 years.

MATERIALS AND METHODS

One hundred and nine patients were treated by aspirations and 14 patients underwent neurosurgery; it means that all patients were treated with determined surgical intervention. The surgery was indicated and performed very early, so that the calvaria bone under the ossified cephalhaematoma was intact and there was no need of cranioplasty. The results were excellent, as all patients were treated successfully and no infectious or other complications were observed in all cases.

CONCLUSION

Based on our results, we suggest a more radical therapeutic approach and to perform aspirations if the cephalhaematoma is diagnosed. If calcification develops, early neurosurgery is much easier, allows to achieve better cosmetic result and cranioplasty is not necessary. Early indicated and performed surgery treatment of cephalhaematomas can be considered as simple, safe and effective procedure, therefore a more radical therapeutic approach and early surgical treatment of cephalhaematomas should be recommended.