Child’s Nerv Syst (1998) 14:372–377 © Springer-Verlag 1998 ORIGINAL PAPER Introduction Macrocephaly needing reduction cranioplasty is uncom- mon. Generally, the neurosurgeon and the family are to- gether capable of preventing this condition, but unfortu- nately, if the hydrocephalus is neglected by the parents and/ or its treatment is ineffective, neurosurgeons are some- times confronted with this problem. Reduction cranio- plasty is required in selected cases of macrocephaly when the size and the weight of the head significantly interferes with normal development or with important activities that would otherwise be possible [1,10–12]. Reduction cranio- plasty is also proposed as a treatment modality in the cases of severe craniocerebral disproportion in infancy [7] and in the cases of intractable chronic subdural hematoma in infancy [9]. The paucity of literature about this subject makes it dif- ficult to determine the optimum treatment modality. This report describes two different surgical techniques for re- duction cranioplasty and discusses basic stages of this pro- cedure. Case histories and surgical techniques Case 1 Clinical history A 6-year-old boy presented with severe macrocephaly, particularly with a significant increase in vertical height (Fig. 1). Multiloculated hydrocephalus had been diag- nosed in utero and he was delivered by elective cesarean section. His head circumference at birth was 54 cm. When he was 2 months of age, a ventriculoperitoneal (VP) shunt was inserted. Despite many revisions, his head circum- ference increased continuously until he was 4 years old. He was able to talk at 3 years, but walking was impos- sible. On examination, the patient’s head circumference measured 72 cm. Nasion-inion and bitragal distances were both 70 cm. All calvarial sutures were closed and the bones were thickened. Cognitive development was slightly re- tarded. The patient was sometimes able to stand with as- sistance, but his mobility was seriously impaired by the weight of his head. Two different surgical techniques for reduction cranioplasty Pamir Erdinçler Mehmet Yas ¸ar Kaynar Bülent Canbaz Volkan Etus ¸ Nejat Çıplak Cengiz Kuday Abstract Reduction cranioplasty is required in selected patients when macrocephaly interferes with head control, seating, locomotion, and so- cial acceptance. Two different surgi- cal techniques for reduction cranio- plasty in two cases of older hydroce- phalic patients are described. Em- phasis is placed on the basic stages of the procedure. Key words Reduction cranioplasty · Surgical technique · Macrocephaly Received: 16 June 1997 Revised: 18 February 1998 P. Erdinçler () 1 · M. Y. Kaynar B. Canbaz · V. Etus ¸ · N. Çıplak · C. Kuday Department of Neurosurgery, Cerrahpas ¸a Medical School, Istanbul University, Istanbul, Turkey Mailing address: 1 PK 19, 34312, K. M. Pas ¸a, Istanbul, Turkey Tel.: +90-212-587 6585 Fax: +90-212-632 0026