Enigmas y confusiones en el diagnóstico y tratamiento de la plagiocefalia posicional. Protocolo asistencial

Abstract

Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is considerable confusion in the literature on the terminology and physiopathology of this deformity, as well as its differential diagnosis with true synostosis and treatment recommendations. To clarify these concepts and present a protocol for the management of positional plagiocephaly, which was recently requested by the Health Administration of the Community of Madrid. The protocol aims to achieve coordination among pediatricians and neurosurgeons, as well as to provide precise information on this deformity for parents, pediatricians and neurosurgeons. Previous consensus was reached on a series of data. Infants were classified into three categories of deformity (mild, moderate, severe) according to measurements on digital photographs. Diagnosis and treatment follows two phases: a pediatric phase (up to 5 months of age) and a neurosurgical phase (from 5 months onwards). Infants are referred to neurosurgical consultation only after being treated with postural changes and physiotherapy and only after reaching the age of 5 months. The reasons for this approach are explained in the protocol, which also defines the functions and responsibilities of each specialty. The treatment proposed in the protocol is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.