What is the treatment for a calcified cephalohematoma?

Treatment of Calcified Cephalohematoma

Surgical excision is the definitive treatment for calcified cephalohematoma causing significant calvarial deformity, with the specific surgical technique determined by the type of calcification and presence of inner lamella depression. 1

Classification and Assessment

Calcified cephalohematomas can be classified into two main types:

• Type 1: Normal contoured inner lamella
• Type 2: Depressed inner lamella 2

This classification is critical for determining the appropriate surgical approach.

Treatment Algorithm

Initial Evaluation

• Obtain CT imaging to assess:
  • Thickness of the skull in the bulging area
  • Presence of depression beneath the calcification
  • Extent of calcification

Treatment Options Based on Presentation

1. Early, Incompletely Calcified Cephalohematoma

   • Consider aspiration and compressive dressings 2

2. Fully Calcified Cephalohematoma with Significant Deformity

   • Type 1 (Normal inner lamella):

     • Ostectomy of the outer lamella only 2

   • Type 2 (Depressed inner lamella):

     • Cap radial craniectomy technique
     • Flip-over bull's-eye technique (in selected cases)
     • Simple excision with periosteal reattachment (for smaller defects) 3

Surgical Techniques

Cap Radial Craniectomy

• Involves removal of the calcified cap
• Elevation of the depressed inner lamella
• Reconstruction using the removed calcified material as bone graft 2

Flip-over Bull's-eye Technique

• Novel approach for Type 2 lesions
• Provides excellent cosmetic outcomes in selected patients 2

Simple Excision and Periosteal Reattachment

• Less complicated alternative for smaller defects
• Involves excision of the calcified cap and reattachment of periosteum
• Can be effective even when there is a depressed area after cap removal 3

Timing of Surgery

The University of Michigan's 25-year experience suggests that the optimal timing for surgical intervention is around 8-9 months of age (mean age at surgery was 8.6 months) 1.

Outcomes and Risks

Benefits

• Restoration of normal cranial contours
• Excellent cosmetic outcomes 1

Risks

• Blood loss requiring transfusion (26.7% in the Michigan series)
• Minor complications (13% of cases) 1

Follow-up Care

• Post-operative imaging to confirm restoration of normal contour
• Monitoring for complications
• Long-term follow-up to ensure proper cranial development

Conclusion

Calcified cephalohematoma causing significant calvarial deformity requires surgical correction. The specific technique should be selected based on the type of calcification and presence of inner table depression. With appropriate surgical management, excellent outcomes with restoration of normal cranial contours can be achieved.