Management of cranial deformity following ventricular shunting

Purpose: Ventricular shunt-induced craniosynostosis is a widely recognised cause of secondary craniosynostosis. We reviewed the management and long-term outcome of the cases of cranial deformity post cerebrospinal fluid shunting in our unit and compared these with previously published series. Methods: The Australian Craniofacial Unit and Department of Neurosurgery database was searched to identify cases of ventricular shunt-induced cranial deformity and a case note review was undertaken. Results: Eight cases were identified, and all were shunted within 6 months of birth. Our patients required shunting with a low pressure valve for hydrocephalus secondary to either aqueduct stenosis or intraventricular haemorrhage. The diagnosis was made following computed tomography (CT) three-dimensional surface reconstruction of the skull. Two cases of confirmed suture fusion were treated with cranial vault remodelling and programmable shunt insertion. In six cases, the sutures were not completely fused on the CT images despite a scaphocephalic head shape. These patients were managed conservatively with close monitoring. Conclusion: Cranial vault remodelling together with insertion of programmable shunt valve is indicated in CT confirmed cases of secondary craniosynostosis.