Reduction Cranioplasty Using a Three-dimensional Preoperative Virtual Model for Treatment of Extreme Macrocephaly and Positional Plagiocephaly Secondary to Untreated Hydrocephalus - Case Description and Literature Review

Abstract

Abstract INTRODUCTION Severe macrocephaly may occur due to untreated hydrocephalus and may persist even after treatment. Reductive cranioplasty intends to reduce the infant's head size to optimize motor development. Few surgical techniques of reductive cranioplasty have been reported. We present an innovative technique in which a 3D printed skull model was used to plan the surgery. METHODS A 21-mo-old male from Cape Verde was admitted to our center presenting untreated congenital hydrocephalus, severe macrocephaly and left posterior plagiocephaly. The patient had been initially treated with a right parietal ventriculo-peritoneal shunt placement that was not working for a long time. On admission, his head circumference was 64 cm and he was unable to lift the head up. The shunt was promptly revised but the severe macrocephaly persisted. A reductive cranioplasty was proposed for both functional and cosmetic reasons. The skull was reconstructed from a volumetric CT scan and a 3D volume was printed using a fused deposition modeling printer. This model was then used to simulate the cranioplasty using a total cranial vault remodeling technique. All the removed parts and augmenting cuts of the printed cranial vault were measured and transferred to the patients' skull to replicate the plan. RESULTS The surgical result was very similar to the planned one. One year later, the patient's head circumference was reduced to 59 cm and the cranial deformity had markedly improved. He had acquired head control and was able to sit without support. CONCLUSION Reductive cranioplasty is an off-standard and complex surgery. The authors consider that a preoperative simulation using a 3D computer assisted model may optimize the surgical results.